Preconception Healthcare Delivery at a Population Level: Construction of Public Health Models of Preconception Care Geordan D. Shannon • Corinna Alberg • Luis Nacul • Nora Pashayan Published online: 14 November 2013 Ó Springer Science+Business Media New York 2013 Abstract A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different pre- conception healthcare pathways. Preconception care strate- gies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, pri- mary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980–current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) com- munity outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplemen- tation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, educa- tion, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconception- care delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery. Keywords Preconception care Á Systematic review Á Programme Á Models Á Healthcare delivery Introduction While antenatal care is able both to detect individual risks during pregnancy and to provide secondary and tertiary pre- vention, it does not address primary prevention of congenital disorders. It cannot prevent pre-pregnancy or early pregnancy risks and exposures [1]. The period of embryonic develop- ment where the developing foetus is most sensitive to the maternal environment and possible harmful exposures occurs around 4–10 weeks gestation [2]. This period approximately coincides with a woman’s first and second missed menstrual periods: often, individuals may not even be aware that they are Electronic supplementary material The online version of this article (doi:10.1007/s10995-013-1393-8) contains supplementary material, which is available to authorized users. G. D. Shannon Á N. Pashayan Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK G. D. Shannon (&) Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia e-mail: geord_1@hotmail.com C. Alberg Á L. Nacul PHG Foundation, 2 Worts Causeway, Cambridge, Cambridgeshire CB1 8RN, UK N. Pashayan Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK 123 Matern Child Health J (2014) 18:1512–1531 DOI 10.1007/s10995-013-1393-8