New Zealand GPs could be providing better preconception care

10 May 2017
Doctor measuring a the fundal height on a pregnant woman

A review of New Zealand GPs knowledge about preconception care and gestational weight management has found that they are not providing optimal care.

The study, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, was based on a survey of 200 New Zealand GPs.

The survey explored the GPs’ knowledge of preconception and gestational weight management, as well as their involvement with pregnant patients.

The authors say GPs knowledge about gestational weight gain is vital given maternal obesity and excess gestational weight gain increase the risk of serious health issues for both the mother and child, including pre-eclampsia, gestational diabetes, congenital malformations, birth complications and childhood obesity.

Four key themes emerged from the results:

  • Lack of opportunity: GPs very rarely see women for a preconception consultation
  • Lack of awareness: GPs were not aware of what preconception care involves nor the benefit of preconception interventions for overweight and obese women
  • An important issue: GPs believe preconception care is very important and will become more so with growing obesity rates
  • Need to improve knowledge: GPs said they had little knowledge about weight in pregnancy nor understanding of how to support women with a high BMI.

The authors say there is a mismatch between GPs knowledge and their clinical practice.

“The high level of knowledge regarding the risks associated with obesity and pregnancy and the accepted view of the importance of mitigating this during the preconception period was not reflected in the GPs' reported clinical practice.”

They go on to say that there is also little awareness about the specific supplement requirements for obese pregnant women.

“As little as 4 and 7% of GPs, respectively, would recommend vitamin D or increased-dose folic acid supplementation to those with a raised BMI and 65% of GPs were unaware, or unsure, of the increased risk for congenital malformation.

“Similarly, when New Zealand Lead Maternity Carers were surveyed, less than 50% were aware of the increased risk of congenital malformation associated with obesity and only 3% would recommend vitamin D or increased folic acid supplementation to overweight pregnant women.”

Only 12% of GPs were aware of updated Ministry of Health guidance on supplementation.

The authors note that selection bias may mean the results present a more favourable picture of GP knowledge than is accurate.

They conclude that preconception care provided by GPs does not meet World Health Organisation or Ministry of Health (MOH) standards.

“We have comprehensive MOH Guidance that is poorly known, and practice that is sub-optimal despite considerable acknowledgement of associated risks.

“Maternal and childhood obesity are serious and prevalent issues where preventative measures are paramount to success.

“We recommend the promotion of MOH Guidance, and medical and population education of the benefit and availability of preconception care, as simple steps toward success in reducing the burden of maternal and childhood obesity,” they say.

You can read the full article on GPs and preconception care and gestational weight gain here