Exploring the need for preconception care: the pregnancy experiences of women with pre-existing medical conditions in Ibadan, Nigeria.

Pre-existing medical conditions predisposing to poor maternal and child health outcomes are amenable to preconception care (PCC). Despite an increasing pool of women of reproductive age with pre-existing medical conditions, PCC services are not provided routinely in Nigeria. This study explores the pregnancy experiences of women with pre-existing medical conditions to make a case for PCC services. Nine women having pre-existing medical conditions were purposively selected for in-depth interviews at two referral hospitals for maternal and child health services in Ibadan North LGA, Oyo State, Nigeria. Thematic analysis was done using MAXQDA 2018. There were seven pregnant and two non-pregnant participants having either hypertension, diabetes mellitus, sickle cell disorder, chronic hepatitis, HIV, or secondary infertility. None of the participants were aware of PCC and although they all desired their current pregnancy, there was no active preparation: they neither notified their health care providers about their desire for pregnancy nor had their medications adjusted or changed till after pregnancy. All except one of the participants believed they could have benefitted from PCC if they had been aware before pregnancy. The regular contact with the health system afforded by their pre-existing medical conditions is an opportunity for participants to have been adequately prepared for pregnancy through counselling, adjustment or change in treatment to prevent complications. This opportunity was missed among the study participants. Health care providers need to be proactive and ask women of reproductive age about their pregnancy desires during routine clinic visits in order to make adequate preparation.