To date, emphasis on prenatal care has not resulted in national improvements in pregnancy outcomes (i.e., low birthweight and premature birth), leading to the realization that care during pregnancy, even in early pregnancy, may be too late for primary prevention. Preconception care is a form of primary prevention for promoting health, assessing risk, and intervening to modify risk factors that may improve maternal and infant outcomes. While the need to optimize prepregnancy health to improve pregnancy outcomes has gained recognition in recent years, corresponding increases in the provision of preconception care and its association with favorable behavior during pregnancy has not been evaluated.
In 2006, the Centers for Disease Control and Prevention (CDC) called on clinicians in its
"Recommendations to Improve Preconception Health and Health Care" to improve the health and health care of women before and between pregnancies specifically by integrating elements of preconception care into every primary care visit with women of reproductive age. However, much of the existing data on preconception care services precede this recommendation, and its impact has not been evaluated. Therefore, there is a critical need to evaluate changes in the proportion of women receiving preconception care, determine if that care is reaching women at high risk of adverse outcomes, and gauge how provision of care is associated with positive behavior during pregnancy among women who could benefit. Such knowledge will estimate the degree to which preconception care improves and optimizes health behaviors, resulting in healthier mothers and babies. The rationale for the proposed research is that successful completion would provide a strong basis for better targeting of and access to preconception care services. The objectives of the proposed research are to determine (a) trends in the provision of preconception care 2004-2010, a period when the recognition of the importance of preconception care increased in the health care community; (b) concordance between health messages received before and during pregnancy; (c) the association between specific behaviors before and during pregnancy and receipt of specific preconception care messages.
The proposed research will be a secondary data analysis using multistate data from the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is an ongoing, population based surveillance system collecting data on a wide range of maternal behaviors and experiences before, during, and after pregnancy among women who deliver a liveborn infant. States work with the CDC to administer PRAMS maternal self-completed surveys in 37 states.
This proposal addresses the MCHB Strategic Research Issue #IV: Promoting the healthy development of MCH populations by studying factors associated with utilization of preconception care that positively influence preventive health behaviors of women at various stages of and throughout their life span and Issue #II: MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations by studying how health care utilization differs by race/ethnicity, geographic, income, education, and insurance status. In addition, the basis of this proposal is directly related to Healthy People 2020 Maternal, Infant, and Child Health objectives 16.1-16.4 on preconception health and behaviors.
Preconception Health, Risk Behaviors, Pregnancy, Clinical Practice, Early
Intervention, Health Care Utilization, Access to Health Care