The clinical content of preconception care: Alcohol, tobacco, and illicit drug use exposures

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30345, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 01/2009; 199(6 Suppl 2):S333-9. DOI: 10.1016/j.ajog.2008.09.018
Source: PubMed


Substance abuse poses significant health risks to childbearing-aged women in the United States and, for those who become pregnant, to their children. Alcohol is the most prevalent substance consumed by childbearing-aged women, followed by tobacco, and a variety of illicit drugs. Substance use in the preconception period predicts substance use during the prenatal period. Evidence-based methods for screening and intervening on harmful consumption patterns of these substances have been developed and are recommended for use in primary care settings for women who are pregnant, planning a pregnancy, or at risk for becoming pregnant. This report describes the scope of substance abuse in the target population and provides recommendations from the Clinical Working Group of the Select Panel on Preconception Care, Centers for Disease Control and Prevention, for addressing alcohol, tobacco, and illicit drug use among childbearing-aged women.

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Available from: Robert J Sokol, Apr 23, 2014
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    • "For many women, a positive pregnancy test is a stimulus to cease smoking, yet most women require multiple attempts to quit. Smoking cessation programs for adult men and women have been evaluated and demonstrate higher rates of women who quit before or during the first trimester [104]. Given the strong evidence of risk for preterm birth and low birth weight with tobacco use in pregnancy, it may be inferred that fewer women smoking translates to lower rates of preterm birth. "
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    ABSTRACT: Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid-containing multivitamin supplement) and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.
    Reproductive Health 11/2013; 10 Suppl 1(Suppl 1):S3. DOI:10.1186/1742-4755-10-S1-S3 · 1.88 Impact Factor
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    • "In a study on diabetic women, pre-pregnancy counseling has been reported to reduce congenital abnormalities and defects, and control the blood glucose in the first trimester (lower glycosylated hemoglobin levels).[13] Likewise, other studies confirmed the effects of identifying and educating pre-pregnancy risk factors as well as previous conducted cares on pregnancy output.1415 "
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    ABSTRACT: Pre-pregnancy care is considered as the services assessing and reducing the pregnancy risks through providing medical care and mental support. Therefore, a pre-pregnancy counseling protocol was prepared based on a series of guidelines. This study aimed to determine the effect of the protocol on pregnancy and labor indices. This was a four-phase field study conducted in four randomly selected urban and rural health centers in Shahreza. In the first phase, the information including pregnancy and labor indices was extracted. The participants were all the women who had a delivery in the year before the study (census). In the second and third phases (3 and 6 months after implementing the protocol in the case centers), the process of implementing the protocol was assessed. In the fourth phase (a year later), pregnancy and labor indices were determined in case and control centers (on all the women who had labor in the year before) again and the results were compared in case and control groups as well as before and after implementing the protocol. Data was collected by reviewing documentations and using data collection forms. It was then analyzed by descriptive and analytical statistics using SPSS RESULTS: The obtained results indicated the positive effects of pre-pregnancy cares on cesarean indices, percentage of underlying diseases, pregnancy over the age of 35, and pregnancy intervals of less than 3 years. In addition, the protocol had been implemented correctly in 8.2% of the cases in the second phase, and in 30.2% of the cases in the third phase. The positive effects of pre-pregnancy cares on some of the indices raised the necessity of seriously considering and integrating this program in the routine women's health care programs. Considering that less than one-third of the staff members of the case centers had completely conducted the pre-pregnancy cares, monitoring the staff's performance is essential for improving the effectiveness of the care.
    Iranian journal of nursing and midwifery research 03/2011; 16(4):265-72.
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    • "Of the four million annual pregnancies in the United States, about 40% of women drink some alcohol during pregnancy and about 3-5% of women drink heavily throughout pregnancy (Floyd, Decoufle, & Hungerford, 1999). The prevalence of alcohol use by women during their childbearing years in the United States was 53% in 2006 (Floyd et al., 2008). In pregnant women, frequent alcohol use was reported by 12.5%, and third trimester drinking by 4.6% in 2001 (Floyd & Sidhu, 2004). "
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    ABSTRACT: Fetal alcohol spectrum disorders (FASD) may be common in adolescents and adults in the corrections systems. However, current prevalence estimates for FASD suggest that nearly all affected people are undiagnosed in corrections systems. In this article we provide an overview of our experience with FASD in corrections populations and present strategies for screening, assessment and intervention. We conclude with a plan to provide training to corrections staff in response to identified preferences and needs identified by Canadian and American corrections staff.
    The Journal of psychiatry & law 12/2010; 38(4):559-584. DOI:10.1177/009318531003800408
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