Pre-pregnancy counselling for the primary prevention of birth defects: rubella vaccination and folate intake

To describe women's experiences of pre-pregnancy counselling and their knowledge of rubella immunity and folate intake.

A cross-sectional sample of 121 public and 32 private patients at or less than 20 weeks' gestation attending their first antenatal appointment completed a self-administered questionnaire.

Awareness of the importance of rubella immunity and folate intake; and the proportion of women who discussed these with their general practitioner (GP) before pregnancy.

Rubella: 59% correctly identified the effect of rubella infection in pregnancy and 86% had been vaccinated. Women born in Australia, New Zealand or the United Kingdom were nearly 16 times more likely to have been vaccinated against rubella than those born elsewhere. Folate: 54% knew of the protective effect of folate, 30% correctly identified the timing of this effect, 72% correctly identified some of the sources of dietary folate, and 13% had increased their folate intake before pregnancy. In 49% of women their GP was aware of their intention to conceive, but rubella had not been discussed with the GP before 50% of these planned pregnancies, and in 80% the issue of folate had not been discussed. Private patients were more likely to have had their rubella immune status checked and to have increased their folate intake compared with public patients.

Pre-pregnancy counselling about rubella immunity and folate intake is underused in the primary prevention of birth defects. Given the high proportion of unplanned pregnancies, primary prevention strategies for birth defects must involve all women of child-bearing age and not simply those planning a pregnancy.