Developing & delivering interventions for pregnancy to reduce mother & child deaths

A global group of experts has established research priorities addressing care for women prior to pregnancy, in a consensus statement published in PLOS Medicine this week. Sohni Dean and Zulfiqar Bhutta from the Aga Khan University, Karachi, collaborated with colleagues to identify the most important research areas for preconception care that need to be addressed in order to reduce deaths and disability in women and children.

Prevention of maternal and child mortality has featured prominently in the Millennium Development Goals and the subsequent follow-up targets, but to date there has been little focus on how better preparation for pregnancy could impact on these deaths. The aim of preconception care is to improve outcomes for women, mothers and babies by ensuring that a woman enters pregnancy in the best state possible, but little work has been undertaken on interventions that achieve this purpose.

International experts in maternal and child health used a meticulous process to highlight the topics for prioritization in low and middle-income countries, which have the greatest burden of maternal and child deaths. They examined what was already known and then worked through several stages to reach a consensus. The top-scoring research areas were the cost-effective integration of preconception care into wider health-related programs, increasing health promotion and healthcare provision through community health workers, strategies for reducing women's exposure to tobacco smoke, prevention of pregnancies in adolescents, and promoting birth spacing.

An accompanying Perspective from Joel Ray and colleagues at St Michael's Hospital, Toronto, (not involved in the study), welcomes this initiative and acknowledges the enormous amount of work that has gone into identifying the research priorities for this neglected area. They consider which personnel are best placed to deliver the interventions and indicate that improving female education and literacy are important components of the package to reduce maternal and child mortality.

Guidance & Guidelines:

Funding: The Bill & Melinda Gates Foundation funded the two-day meeting of MNCH experts that lead to the second iteration of this exercise. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: This work was funded by a grant from the Bill & Melinda Gates Foundation, at which FD works as a Senior Program Officer and KCT worked as a Program Officer in the Family Health Division. ZAB is a member of the Editorial Board of PLOS Medicine. All other authors have declared that no competing interests exist.

Citation: Dean S, Rudan I, Althabe F, Webb Girard A, Howson C, et al. (2013) Setting Research Priorities for Preconception Care in Low- and Middle-Income Countries: Aiming to Reduce Maternal and Child Mortality and Morbidity. PLoS Med 10(9): e1001508. doi:10.1371/journal.pmed.1001508

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http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001508

Sohni Dean
Albert Einstein Medical Center USA
sohni.dean@gmail.com

Zulfiqar Bhutta
Aga Khan University
Pakistan
zulfiqar.bhutta@aku.edu

Funding: The authors' research programme is funded by the Canadian Institutes of Health Research, which did not play any role in the preparation of this Perspective.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Young CT, Urquia ML, Ray JG (2013) Preconception Care in Low- and Middle-Income Countries: New Opportunities and a New Metric. PLoS Med 10(9): e1001507. doi:10.1371/journal.pmed.1001507

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001507

Joel Ray
University of Toronto
CANADA
RayJ@smh.ca