Article révisé par les pairs
Résumé : Introduction: Preconceptional clinics and the associated activities seem to be largely accepted but their promotion seems to vary from one country to another. To what extent is this a subjective impression or an objective reality, and which would be the rationale leading to a certain degree of caution in this field? Material and methods: Three approaches were taken: 1. a "PubMed" search; 2. a review of a sample of national recommendations, their presentation and their contents; 3. a research of the first 30 sites listed by Google in Belgium using the keyword "preconception". Results: 1. Among the 226 identified publications, only 32% dealt with preconception care, and only 16% presented research/evaluation data. The remainder of the publications related to physiology. 2. The contents of the recommendations were relatively similar; the main difference was the volume of the documents. 3. Less than half of the websites (14/30) were developed by "medical" organizations. The others were run by business firms. Discussion: Several elements can explain the differences between countries. These include all of the following: poor levels of evidence of effectiveness for some components; mix of validated and non validated recommendations; benefits mainly to the educated middle class; predominance of the Western cultural model and finally the appropriateness of limiting healthy lifestyle recommendations to families intending to have a child. Conclusion: The variations in enthusiasm for the concept of the preconception care may well reflect societal variations, explaining the differences between countries. To what point preconceptional care outside specific medical conditions is, or is not, a priority for public health action warrants further analysis, based on more evidence. © 2012 Springer-Verlag France.