Preconception Care for People With Health Conditions: What Approaches Work, for Whom, and in What Circumstances? A Realist Review

Preconception care for people with chronic health conditions is recommended in view of the implications for them and their offspring during pregnancy and beyond. This realist review of published and grey literature explored factors that explain why people seek or receive appropriate preconception counseling and why they engage in recommended health behavior change prior to pregnancy. Fifty-two studies contributed to phase one synthesis, and 38 studies provided explanations in phase two. Ten program theories were developed, explored, and refined through iterative discussion and coding. Causal explanations of the ways in which components of preconception care contribute to effective access to care and prepregnancy behavior change were identified. Beneficial components included continuity of carer (promoting trust), a partnership approach (empowering people who feel valued), promoting an integrated approach across primary and secondary care, offering psychological counseling (recognizing the link between physical and psychosocial aspects of living with health conditions), considering sexual and reproductive health as part of routine care, and normalizing conversations about preconception care (to reduce the barrier created by social and cultural norms). These key aspects have been highlighted for consideration when planning, implementing, and improving preconception care services for people with health conditions.