Expanded contraceptive counseling increases knowledge about fertility and awareness of preconception health
By: Grace Gearhart, DO
Editor’s Note: At FACTS, our focus is to share the science supporting the important role of fertility awareness-based methods (FABMs) and restorative reproductive medicine to enable our colleagues to help patients achieve their reproductive health goals. The reproductive life plan provides an ideal way to introduce information to patients and encourage them to carefully consider their family planning goals. Stay tuned for more information about our upcoming FACTS Conferences, where we plan to address this topic in more depth.
Introduction
“The first step in making lifestyle changes is to understand what changes are needed and why.”[1] Skogsdal et al conducted research to gauge baseline knowledge about fertility and the impact of lifestyle factors on reproductive health and pregnancy outcomes. In this study, the researchers discovered their community did not understand the importance of lifestyle factors.[1] Among the community in Sweden, 40% of women were overweight or obese early in pregnancy, and many women were unaware of the adverse effects of Swedish snuff and alcohol intake prior to conception. Regarding folic acid, only 40% of women planning to conceive knew and understood why this is an important supplement. The study findings revealed a clear need for greater promotion of information among women, which led to the second phase of research: to assess the impact of an educational intervention on preconception lifestyle and pregnancy outcomes.
The aim of this study was to gauge the influence of Reproductive Life Plan Counseling (RLPC) on future pregnancy outcomes and lifestyle habits in women receiving standard contraceptive counseling. RLPC includes information on fertility and reproduction, assesses a woman’s reproductive goals, how to achieve those goals, and information on unhealthy behaviors that can negatively impact reproduction.[1]
“Reproductive Life Plan counseling includes information on fertility and reproduction, assesses a woman’s reproductive goals, how to achieve those goals, and information on unhealthy behaviors that can negatively impact reproduction.”
Methodology
This randomized controlled trial included 1,946 Swedish-speaking women aged 20-40 years. Participants were divided into an intervention group that received RLPC in addition to standard contraceptive counseling and a control group that only received standard contraceptive counseling.
Reproductive Life Plan Counseling opened by asking, “Do you wish to have children/more children in the future?” Depending on the answer, the intervention was taken through different discussion points. If a participant answered “yes” to this question, the discussion focused on preconception health, folic acid, and using contraception until ready. If she answered “no,” they discussed general preconception health and choosing effective contraception. If she replied, “yes, but later on in life,” the topics addressed included contraception, preconception health, and knowledge about fertility and aging. The intervention group also received an informational booklet on fertility and health.
Prior to receiving counseling, both groups completed a questionnaire to assess baseline knowledge, and a follow-up questionnaire was completed two months later. Given that this is a planned longitudinal study, the researchers will follow the pregnancy outcomes, contraceptive measures, and possible lifestyle changes of the intervention group as compared to the control group.
Results
In the first questionnaire, baseline knowledge was found to be low. Whereas the probability of becoming pregnant each cycle is 30-35%, 64% of women thought the probability was over 60%. Only 16.7% of the participants correctly answered that the lifespan of an ovum after ovulation is one day. While the probability of having a successful in vitro fertilization birth is 25-30%, 51.9% of women incorrectly answered 50% or more. 28% of the participants did not know about the importance of taking folic acid in pregnancy.
“In the first questionnaire, baseline knowledge was found to be low. Only 16.7% of the participants correctly answered that the lifespan of an ovum after ovulation is one day.”
In the preliminary survey, 79% of the women were already “very satisfied” with their current contraception, a fact that needs to be taken into account when looking at the results of the contraceptive measures data after the intervention. These were some of the significant knowledge deficits in the first survey before the interventions.
In the intervention group, knowledge of fertility and preconception health increased after the RLPC intervention with statistical significance. Many of the participants stated they planned to make lifestyle changes based on this new information and noted they appreciated the intervention. Furthermore, 76% of them suggested that RLPC should be a part of routine counseling.
The researchers also evaluated whether asking women to reflect on their child-bearing intentions would increase or change the use of contraceptive measures. There was no difference between the groups on use of contraceptives after the intervention. However, with most of the women already “very satisfied” with their current contraception, this was less likely to change after the intervention.
Discussion
These data show that RLPC, in conjunction with standard contraceptive counseling, may have a significant role in increasing knowledge of fertility, reproduction, and preconception health. The women in the study appreciated the intervention and suggested its use, and the researchers propose that contraceptive counseling presents an opportunity to introduce this intervention.[1] The future data in the longitudinal study will be crucial to further assess whether health promotion with RLPC will impact lifestyle significantly enough to justify investing in resource development to make it a feasible option for the general population.
“Reproductive Life Plan Counseling, in conjunction with standard contraceptive counseling, may have a significant role in increasing knowledge of fertility, reproduction, and preconception health.”
This study presented a small subset of women who appreciated learning about their fertility and how healthy habits influence both fertility and pregnancy outcomes. Obesity, smoking, and alcohol consumption are some of the factors that can negatively affect fertility. Supplements such as folic acid, myoinositol, omega-3 fatty acids, fish oil, and vitamin D have positive roles in fertility.
During the FACTS elective, medical and health professionals learn the facts about women’s fertility in hopes of assisting them with family planning and learning how to treat medical conditions cooperatively with a woman’s cycle. We can then empower women with this broader knowledge of their fertility. The more this information is promoted by researchers, such as in this study and through FACTS, the more women will recognize why they need to make lifestyle changes, and then act on it. This optimization of health will impact not only fertility and pregnancy outcomes but also overall physical and emotional health, healthcare cost and resources.
More studies like this one are needed. Ideally, the next step would be to conduct a similar study in a larger population worldwide. It could be beneficial to conduct a comparable study adding fertility awareness-based methods to RLPC with contraceptive counseling and assessing outcomes, such as the number of people switching contraceptive methods, the desire to learn more, pregnancy outcomes, and whether these methods proved valuable in diagnosing medical conditions.
Sources
[1] Skogsdal Y, Fadl H, Cao Y, Karlsson J, Tydén T. An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial. Ups J Med Sci. 2019;124(3):203-212. doi:10.1080/03009734.2019.1653407.
ABOUT THE AUTHOR
Grace Gearhart
Grace Gearhart is a first-year resident at Wesley Family Medicine in Wichita, KS. She is a graduate of Kansas City University, having completed her first two years of medical school in Joplin, MO, and her final two years in Wichita, KS. She is from Wichita and plans to practice family medicine there. Grace desires to encourage and aid women in using FABMs for their family planning goals and to diagnose medical conditions. She took the FACTS electives to gain a more comprehensive understanding of the world of FABMs and how to incorporate them in patient care.
