Four key elements included in national and international guidelines have been omitted, experts say.
Researchers have identified key gaps in the RACGP’s latest Red Book, warning that Australia’s primary care guidelines for preconception care overlook several important elements that are recognised internationally.
According to a review from researchers from the School of Public Health, University of Queensland, the 2024 edition of the Red Book, which was the first update in eight years, missed four important elements of preconception care (PCC) that were included across various other guidelines.
Emerging evidence indicates that men’s health during the preconception period can significantly influence reproductive outcomes, but male preconception care was omitted from the Red Book.
Factors such as smoking, alcohol use, obesity and environmental exposures can affect semen quality, impacting both fertility and pregnancy outcomes. Research suggests that improved semen quality during the preconception period is associated with higher fecundability and a reduced risk of miscarriage.
“Priorly, many preconception care models have largely focused on maternal factors, with limited emphasis on the inclusion of males in preconception care,” Professor Gita Mishra AO, director of the UQ’s Australian Women and Girls’ Health Research Centre and co-author of the study, told The Medical Republic.
“However, evidence regarding male partner health and reproductive outcomes is expanding, and this is likely to be an area of growing attention in future PCC guidance.”
Screening for sexually transmitted infections, intimate partner and domestic violence prior to conception have previously been identified as among the top ten priorities in Australia to ensure a healthy pregnancy. Despite this, and the known adverse outcomes linked to infections such as chlamydia and gonorrhoea during pregnancy, the current Red Book does not include routine screening for chlamydia or gonorrhoea prior to conception.
It does recommend hepatitis B immunisation for women with incomplete immunity at preconception, but instead of identifying risks from STIs in pregnancy planning, screening is recommended as part of antenatal care once a pregnancy is already established.
“Given the increasing rates of some STIs and its potential impact on reproductive health, we believe that screening for these STIs can be initiated for women considering pregnancy and included as part of PCC,” Professor Mishra said.
Similarly, women who experience domestic and family violence before pregnancy have been shown to be at increased risk of negative maternal and neonatal outcomes, including miscarriage, preterm birth and low birth weight.
Exposure to violence is also associated with higher rates of antenatal anxiety and prenatal depressive symptoms, both of which can contribute to poorer pregnancy outcomes. Preconception screening could represent an opportunity for early identification and intervention.
“Screening for IPV is well recognised in antenatal care visits or when women present with clinical indicators or possible experiences of IPV. However, it is also important to consider a routine IPV screening for women considering pregnancy to improve health outcome,” said Professor Mishra.
Another important consideration, the authors noted, was the care of women who had experienced female genital mutilation.
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International guidelines, including those from the Public Health Agency of Canada and the International Federation of Gynaecology and Obstetrics, recommend that healthcare providers offer respectful care and support for women with a history of this practice prior to conception.
Although the prevalence of female genital mutilation varies widely between populations, estimates suggest that tens of thousands of women living in Australia have experienced female genital mutilation during their lifetime.
Evidence indicates that these women face an increased risk of obstetric complications during childbirth, including postpartum haemorrhage – the leading cause of maternal morbidity and mortality worldwide – as well as prolonged labour and perineal tears.
“In countries like Australia, FGM is particularly relevant in the context of migration and culturally responsive healthcare,” Professor Mishra said.
“From a clinical perspective, FGM is associated with specific obstetric outcomes, and provider awareness is essential for appropriate and sensitive care.
“We are hopeful that the preconception care elements identified in our review will be incorporated into future updates of the RACGP Red Book.”
At the time of publication, the RACGP had not responded to our request for comment.
