Laura GibsonHealth and Wellbeing SpecialistHealth and Wellbeing Specialist

DG Health & WellbeingNHS Dumfries & Galloway

Partners/contributors:Maggie Gurney, Sexual Health Director

l l d fNatalie Potts, Specialist MidwifeCatherine Smith, Service Development Pharmacist

The health status of any woman or man before aThe health status of any woman or man before a pregnancy is conceived, regardless of pregnancy intentionClear link between a baby’s health and their mothers health before (and between) pregnanciesHealthy women and men are more likely to have healthy babies who grow into healthy children P i i i f llPreconception is important for men as well as women

By taking actions to optimise health prior to a pregnancyBy taking actions to optimise health prior to a pregnancy being conceived, the risk of adverse outcome can be significantly reduced and the health of the mother, father and baby maximisedbaby maximised

Improving the general health of the whole population through increasing knowledge and understanding of healthy lifestyles should be an underlying philosophy of all health, education and social servicesa d soc a se ces

Preconception health messages can easily be included with th l h lth lif t lother general healthy lifestyle messages

First trimester of pregnancy is when fetal development is most vulnerable

Health promotion for pregnancy begins at first contact with Maternity Services – usually 8-12 weeks

Many women (and men) are not aware that they are pregnant and continue negative health behaviours during this periodand continue negative health behaviours during this period

Every contact is a health improvement opportunityEvery contact is a health improvement opportunity

All service providers who have contact with children, young l d d f d kpeople, and women and men of reproductive age can make a

significant impact

Utilise formal and informal opportunities at every contact to promote health and wellbeing and to support healthy lifestyle choices/changeschoices/changes

Can impact on planned and unplanned pregnanciesp p p p g

For women reproduction spans nearly four decades

F hi i lFor men this is even longer

During this time, pregnancy intentions and risks are likely toDuring this time, pregnancy intentions and risks are likely to change

h f h l h d dTherefore preconception health promotion and care needs to be delivered from the early years right across the life course

Faculty of Public Health Scotland Conference 2013Faculty of Public Health Scotland Conference 2013

Working Group established:Working Group established:Public Health Maternity ServicesSexual Health PharmacyObstetrics & Gynaecology GPy gyEducation Further/Higher EducationSocial Work Youth Work

Assessment of current activity

Consideration of evidence base

High level outcome: All men and women of reproductiveHigh level outcome: All men and women of reproductiveage enter pregnancy in optimal health.

d l lMedium level outcomes:◦ All men and women of reproductive age have

improved knowledge, attitudes and behavioursp g ,around preconception health◦ All men and women of reproductive age receive

appropriate preconception care servicesappropriate preconception care services◦ Risks indicated by a previous adverse pregnancy

outcome are reduced through interconceptualinterventionsinterventions◦ Inequalities in pregnancy outcome are reduced

Low level outcomes:a) Primary Care staff, and women and men of reproductive age, are aware of the preconception

health services offered by Maternity Services and Gynaecologyb) Women and men contemplating pregnancy and/or trying to conceive discuss preconception

health with their GP or other health practitioner c) Pharmacies offer information on preconception healthc) Pharmacies offer information on preconception healthd) Relevant local websites promote preconception healthe) Sexual Health Services offer preconception care to women not using contraception, women

aged over 35 and women with complex contraceptive needsf) Specialist Drug and Alcohol Services routinely enquire about pregnancy intention and

ti h lthpreconception healthg) Preconception health is included within routine review of women who have risk indicators for

adverse pregnancy outcome

h) All relevant staff teams (including Social Work Health Visiting School Nursing Paediatricsh) All relevant staff teams (including Social Work, Health Visiting, School Nursing, Paediatrics, Specialist Drugs and Alcohol, Child and Adolescent Mental Health, Primary Care, Sexual Health and Education) ) are aware of risk indicators and promote preconception health at all relevant contacts

i) Preconception health is integral to Curriculum for Excellence health and wellbeing learningi) Preconception health is integral to Curriculum for Excellence health and wellbeing learning experiences for all children and young people

j) Preconception health continues to be embedded within the nursing curriculumk) D&G College students promote preconception health with their peers

MethodologyMethodology◦ Early Years Collaborative Improvement Methodology

T d i S l H l h d C i Ph i◦ Tested in Sexual Health and Community Pharmacies

BaselineS lf t d k l d fid◦ Self-rated knowledge, confidence

◦ Frequency of offering preconception advice◦ Circumstances of offering preconception advicePost ToolkitPost-Toolkit◦ Self-rated knowledge, confidence◦ Helpfulness of Toolkit◦ helpful/unhelpful content◦ helpful/unhelpful content◦ Likelihood to discuss with service users3 month follow-up

F f ff i ti d i◦ Frequency of offering preconception advice◦ Circumstances of offering preconception advice◦ Estimated number of service users receiving information/advice since

Toolkit◦ Feedback on patients who have made a lifestyle change/sought additional

support

High or very high knowledge 11% 75%High or very high confidence 11% 75%100% quite or very likely they would discuss with service users

Conclusion: The Dumfries and Galloway Preconception Health Toolkit is effective at increasing the knowledge, skills and confidence of staff across all sectors to talk with their service users about preconception health.

January 2017January 2017

Multi-agency invitationMulti agency invitationOral Health Social Work PharmacyWomen’s Aid Pregnancy Crisis Tobacco ControlSexual Health Maternity CAMHSSexual Health Maternity CAMHSRheumatology Diabetes Drugs and AlcoholHealth Visiting Youth Work LAC HealthNHS Health Scotland

Key note speaker: Dr Jonathan Sher

Working Group meeting followed

NHSNHS◦ Health Visiting◦ Diabetes teamDiabetes teamLocal Authority◦ Looked After Private Accommodation ProvidersLooked After Private Accommodation ProvidersThird Sector◦ Youth Work providersYouth Work providers

◦ Much work still to be done…!

WoS MCN GuidelineWoS MCN Guideline

Scottish Government / NHS Health Scotland – MINScottish Government / NHS Health Scotland MIN Framework / CH&YP Public Health Group

Regional working with NHS Lanarkshire, NHS Ayrshire & Arran and NHS Greater Glasgow & Clyde

Email: lauragibson1@nhs.netPhone: 01387 272730