Guidelines for preventive activities in general practice

Reproductive and women’s health

Interconception

      1. Interconception

Reproduction and women's health | Interconception

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0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 ≥80

Interconception, or interpregnancy care, can be defined as the care provided to women and their partners between pregnancies in order to improve outcomes for both women and infants.1,2 The interconception period presents an opportunity to address medical issues (both physical and mental, including intimate partner violence) that have arisen in the preceding pregnancy/pregnancies or postpartum period , provide education regarding optimal pregnancy spacing, provide contraception and consider and address lifestyle risk factors.2 Implementation of this in reality can be challenging due to the competing priorities brought about by new parenthood.

Given the potential risk of adverse outcomes in both the mother and child, interpregnancy interval is a modifiable risk factor.2 Interconception care is particularly important given the increasing rates of chronic disease in people of childbearing age.2 GPs can prepare for interconception care during pregnancy by developing a postpartum plan that includes the patient’s wishes for future pregnancies.1

The following recommendations should be considered alongside those provided in Preconception care.

Case finding

Recommendation Grade How often References
Future fertility intentions
Ask women about their future fertility intentions and provide contraception and/or preconception care planning accordingly.
Practice point Antenatally and after childbirth. Opportunistically at other times. 1, 3
Eligibility for contraception
Review patient factors and existing medical conditions (including those that developed during pregnancy), in relation to medical eligibility for contraception is recommended. For guidance on the possible methods of contraception, see Further information.
Conditionally recommended After childbirth. 3
Conditions during pregnancy
Review whether the woman:
  • developed any conditions during a previous pregnancy (e.g. gestational diabetes, postpartum depression, hypertension) or
  • had any event occur during her labour or delivery (e.g. postpartum haemorrhage, traumatic birth)
  • experienced any other pregnancy or fetal outcome (e.g. small for gestational age or preterm labour)
that could impact on a future pregnancy or her future health or wellbeing and manage that condition to prevent future adverse outcomes.
Practice point After childbirth. 1

Preventive activities and advice

Recommendation Grade How often References
Contraception
Additional contraceptive precaution is not required if contraception is initiated immediately or within 21 days after childbirth.
Practice point N/A 3
Timing of commencement of contraception
  • Initiating effective contraception as soon as possible after childbirth for both breastfeeding and non-breastfeeding women is recommended. Sexual activity and ovulation may resume very soon after delivery.
  • Women should be advised that although contraception is not required in the first 21 days after childbirth, most methods can be safely initiated immediately, with the exception of combined hormonal contraception (CHC).
 
Timing of Long Acting Reversible Contraception (LARC) insertion after delivery
  • Advising patients that intrauterine contraception (IUC) and progestogen-only implant (IMP) can be inserted immediately after delivery is recommended.
 
Conditionally recommended N/A 3
Interpregnancy intervals
Advise women to avoid interpregnancy intervals shorter than 6 months. See Further information for risks of short interpregnancy intervals.
Conditionally recommended N/A 4,5,6
 
 
 

Research has shown that many women are unaware of the risks of short interpregnancy intervals, and this should be discussed with the woman as part of reproductive planning and/or postpartum care.2 

Potential adverse outcomes due to a shorter (six months) interpregnancy interval

Women with shorter interpregnancy intervals are more likely to experience:2,7–9

  • placental abruption
  • placenta praevia
  • uterine rupture (for women who previously had a caesarean section)
  • gestational diabetes.

Potential adverse outcomes for neonates include:2,10–12

  • increased risk of stillbirth
  • small size for gestational age
  • preterm delivery
  • neonatal death. 

The UK medical eligibility criteria for contraceptive use provides guidance on the possible methods of contraception that can be used by patients with specific health conditions or characteristics.

GPs should be aware that contraceptive implant soon after childbirth or the insertion of IUC at the time of either vaginal or caesarean delivery is convenient and highly acceptable to women. This has been associated with high continuation rates and a reduced risk of unintended pregnancy.3 An intrauterine device (IUD) can be safely inserted at time of delivery, or within 10 minutes of delivery of the placenta, or within the first 48 hours after uncomplicated caesarean section or vaginal birth. After 48 hours, insertion should be delayed until 28 days after childbirth.3

 
 

There are no specific interconception recommendations for Aboriginal and Torres Strait Islander peoples.

  1. Louis JM, Bryant A, Ramos D, et al. Interpregnancy care. Am J Obstet Gynecol 2019;220(1):B2–18. doi: 10.1016/j.ajog.2018.11.1098.
  2. Dorney E, Mazza D, Black KI. Interconception care. Aust J Gen Pract 2020;49(6):317–22. doi: 10.31128/AJGP-02-20-5242.
  3. Faculty of Sexual and Reproductive Healthcare (FSRH). FSRH guideline: Contraception after pregnancy. FSRH, 2020 [Accessed 5 March 2024].
  4. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Birth after previous caesarean section (C-Obs 38). RANZCOG, 2019 [Accessed 5 March 2024].
  5. Royal College of Obstetricians and Gynaecologists (RCOG). The investigation and management of the small-for-gestational-age fetus: Green-top guideline no. 31. RCOG, 2014 [Accessed 5 March 2024].
  6. Royal College of Obstetricians and Gynaecologists (RCOG). Birth after previous caesarean birth: Green-top guideline no. 45. RCOG, 2015 [Accessed 5 March 2024].
  7. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 2006;107(4):771–78. doi: 10.1097/01.AOG.0000206182.63788.80.
  8. Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol 2010;115(5):1003–06. doi: 10.1097/AOG.0b013e3181d992fb.
  9. Hanley GE, Hutcheon JA, Kinniburgh BA, Lee L. Interpregnancy interval and adverse pregnancy outcomes: An analysis of successive pregnancies. Obstet Gynecol 2017;129(3):408–15. doi: 10.1097/AOG.0000000000001891.
  10. Basso O, Olsen J, Knudsen LB, Christensen K. Low birth weight and preterm birth after short interpregnancy intervals. Am J Obstet Gynecol 1998;178(2):259–63. doi: 10.1016/S0002-9378(98)80010-0.
  11. Fuentes-Afflick E, Hessol NA. Interpregnancy interval and the risk of premature infants. Obstet Gynecol 2000;95(3):383–90. doi: 10.1016/S0029-7844(99)00583-9.
  12. Zhu BP, Le T. Effect of interpregnancy interval on infant low birth weight: A retrospective cohort study using the Michigan Maternally Linked Birth Database. Matern Child Health J 2003;7(3):169–78. doi: 10.1023/A:1025184304391.
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