Maria Ekstrand RNM PhD

Post doc researcher Uppsala University Sweden

mariaekstrandkbhuuse

What is Preconception

Health and Care

A set of interventions that aim to identify and modify biomedical behavioral and social risks to the womans health or pregnancy outcome through prevention and management Certain steps should be taken before conception or early in pregnancy to optimize pregnancy outcomes and prevent maternal mortality httpswwwhealthnygovpublications2026pdf httpwwwcdcgovpreconceptionindexhtml

Individual

Prevent unwanted

pregnancies

Lower the risk for

involuntary childlessness

Lower the risk for adverse

pregnancy outcome

Benefits of good preconception

Health and Care

Maria Ekstrand Uppsala University

Society

Lower costs (Abortions)

Lower costs (ART)

Lower health care

costs

Benefits of good preconception

Health and Care

Maria Ekstrand Uppsala University

Maria Ekstrand Malmouml University

Why research on preconception care

Preconception care is important for screening prevention and management of risk factors affecting pregnancy outcomes (ie obesity smoking alcohol) Preconception care could have long-term benefits for future generations

Preconception care ndash still an emerging concept in many European countries Collaborative research required in order to develop evidence based policies guidelines and recommendations

What is the

PrePreg Network

An international research network with the overall aims to

1) increase knowledge about preconception health and care ndash including pregnancy planning health lifestyle habits and wellbeing prior to conception

2) improve knowledge of fertility and improve health promoting behavior in relation to pregnancy planning

Sweden

Denmark

Finland

England

Belgium

Italy

Participants are from

The Netherlands

France

Ukraine

USA

Maria Ekstrand Uppsala University

The PrePreg Network ndash how did it start

bull 1st European Congress in Preconception Care and

Health in Brussels October 2010

bull A great need for international research on Preconception

Health and Care

bull Outline of the PrePreg Network formed during the

congress

Maria Ekstrand Uppsala University

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Society

Lower costs (Abortions)

Lower costs (ART)

Lower health care

costs

Benefits of good preconception

Health and Care

Maria Ekstrand Uppsala University

Maria Ekstrand Malmouml University

Why research on preconception care

Preconception care is important for screening prevention and management of risk factors affecting pregnancy outcomes (ie obesity smoking alcohol) Preconception care could have long-term benefits for future generations

Preconception care ndash still an emerging concept in many European countries Collaborative research required in order to develop evidence based policies guidelines and recommendations

What is the

PrePreg Network

An international research network with the overall aims to

1) increase knowledge about preconception health and care ndash including pregnancy planning health lifestyle habits and wellbeing prior to conception

2) improve knowledge of fertility and improve health promoting behavior in relation to pregnancy planning

Sweden

Denmark

Finland

England

Belgium

Italy

Participants are from

The Netherlands

France

Ukraine

USA

Maria Ekstrand Uppsala University

The PrePreg Network ndash how did it start

bull 1st European Congress in Preconception Care and

Health in Brussels October 2010

bull A great need for international research on Preconception

Health and Care

bull Outline of the PrePreg Network formed during the

congress

Maria Ekstrand Uppsala University

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Maria Ekstrand Malmouml University

Why research on preconception care

Preconception care is important for screening prevention and management of risk factors affecting pregnancy outcomes (ie obesity smoking alcohol) Preconception care could have long-term benefits for future generations

Preconception care ndash still an emerging concept in many European countries Collaborative research required in order to develop evidence based policies guidelines and recommendations

What is the

PrePreg Network

An international research network with the overall aims to

1) increase knowledge about preconception health and care ndash including pregnancy planning health lifestyle habits and wellbeing prior to conception

2) improve knowledge of fertility and improve health promoting behavior in relation to pregnancy planning

Sweden

Denmark

Finland

England

Belgium

Italy

Participants are from

The Netherlands

France

Ukraine

USA

Maria Ekstrand Uppsala University

The PrePreg Network ndash how did it start

bull 1st European Congress in Preconception Care and

Health in Brussels October 2010

bull A great need for international research on Preconception

Health and Care

bull Outline of the PrePreg Network formed during the

congress

Maria Ekstrand Uppsala University

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

What is the

PrePreg Network

An international research network with the overall aims to

1) increase knowledge about preconception health and care ndash including pregnancy planning health lifestyle habits and wellbeing prior to conception

2) improve knowledge of fertility and improve health promoting behavior in relation to pregnancy planning

Sweden

Denmark

Finland

England

Belgium

Italy

Participants are from

The Netherlands

France

Ukraine

USA

Maria Ekstrand Uppsala University

The PrePreg Network ndash how did it start

bull 1st European Congress in Preconception Care and

Health in Brussels October 2010

bull A great need for international research on Preconception

Health and Care

bull Outline of the PrePreg Network formed during the

congress

Maria Ekstrand Uppsala University

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Sweden

Denmark

Finland

England

Belgium

Italy

Participants are from

The Netherlands

France

Ukraine

USA

Maria Ekstrand Uppsala University

The PrePreg Network ndash how did it start

bull 1st European Congress in Preconception Care and

Health in Brussels October 2010

bull A great need for international research on Preconception

Health and Care

bull Outline of the PrePreg Network formed during the

congress

Maria Ekstrand Uppsala University

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

The PrePreg Network ndash how did it start

bull 1st European Congress in Preconception Care and

Health in Brussels October 2010

bull A great need for international research on Preconception

Health and Care

bull Outline of the PrePreg Network formed during the

congress

Maria Ekstrand Uppsala University

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Thank you

Maria Ekstrand Lecturer Malmouml University MariaEkstrandmahse

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Research activities - publications

bull First collaboration a literature review on preconception care and

existing guidelines in six European countries (Shawe et al 2015)

bull Development of a questionnaire with a validated instrument

measuring pregnancy planning enabling comparison between

countries (Backhausen et al 2014)

bull Evaluation of a preconception consultation instrument a

ldquoReproductive Life Planrdquo (Stern et al 2013)

Maria Ekstrand Uppsala University

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Research activities - ongoing and upcoming

bull Continue measuring attitudes to parenthood pregnancy planning and

knowledge of fertility in Europe (SWE DK)

bull Examining health and lifestyle habits prior to during and after pregnancy

(native and foreign-born women in several countries) (SWE DK)

bull Reproductive Life Plan among men (SWE)

bull Determinants of intention of preconception care use (BE)

bull Attitudes knowledge and practice of preconception care in GPrsquos and

midwives (BE)

bull Will googling for preconception care result in information consistent with

international guidelines (BE)

bull Start At The Beginning a nutrition and lifestyle digital intervention for

women planning a pregnancy (UK)

bull A randomized controlled trial evaluating the dose of 40 mgday vs 04

mgday of folic acid (IT)

Maria Ekstrand Uppsala University

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

In addition to researchhellip

bull Guidelines

bull Websites

bull Brochures for professionals and lay people

bull 3rd European Congress on Preconception Health and Care

Maria Ekstrand Uppsala University

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Websites

Maria Ekstrand Lecturer Uppsala University

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Maria Ekstrand Lecturer Malmouml University

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Maria Ekstrand Lecturer Malmouml University

httpwwwpubcareuuseecphc2016

Some publications Backhausen MG1 Ekstrand M Tydeacuten T Magnussen BK Shawe J Stern J Hegaard HK Pregnancy planning and lifestyle prior to conception and during early pregnancy among Danish women Eur J Contracept Reprod Health Care 2014 Feb19(1)57-65

Stern J Larsson M Kristiansson P Tydeacuten T Introducing reproductive life plan-based information in contraceptive counselling an RCT Hum Reprod 2013 Sep28(9)2450-61

Tydeacuten T Stern J Nydahl M Berglund A Larsson M Rosenblad A Aarts C

Pregnancy planning in Sweden--a pilot study among 270 women attending antenatal clinics Acta Obstet Gynecol Scand 2011 Apr90(4)408-12

Stephenson J Patel D Barrett G Howden B Copas A Ojukwu O Pandya P Shawe J (2014) How do women prepare for pregnancy Preconception experiences of women attending antenatal services and views of health professionals PLoS One United States 9 (7) httpwwwplosoneorgarticlefetchObjectactionuri=info3Adoi2F1013712Fjournalpone0103085amprepresentation=PDF

Shawe J Delbaere I Ekstrand M Hegaard H Larsson M Mastroiacovo Stern J Steegers E Stephenson J Tyden T Preconception care policy guidelines and recommendations across six European countries Belgium Denmark Italy the Netherlands Sweden and the nited Kingdom Eur J Contracept Reprod Health Care (Submitted)

Maria Ekstrand Uppsala University

Contact persons

Maria Ekstrand and Tanja Tydeacuten Uppsala University Sweden

MariaEkstrandmahse

Hanne Heegard Danish Rigshospitalet Denmark

hkhegaardhotmailcom

Jill Shawe University College London Great Britain

jshawesurreyacuk

Ilse Delbaere University of Ghent Belgium

IlsedelbaereUGentbe

Pierpaolo Mastroiacovo International Clearinghouse for Birth

Defects Italy

icbdicbdorg Maria Ekstrand Uppsala University

Thank you