Recommendations to improve preconception health and health care—United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care

Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 05/2006; 55(RR-6):1-23.
Source: PubMed

ABSTRACT This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives.

    • "Preconception care has been recognized as a crucial component of health care for women of reproductive age. The main goal of preconception care has been defined as to " provide health promotion, screening, and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies " (Johnson et al. 2006). As part of preconception care, various associations (American College of Obstetricians and Gynecologists (ACOG) Committee ACOG The American College of Obstetricians an Gynecologists 2011; Human Genetics Commission 2011) have recommended that preconception screening for some heritable disorders should be offered to couples planning a pregnancy. "
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    ABSTRACT: Cystic fibrosis (CF) is a life-limiting autosomal recessive disorder affecting ~1 in 2500-4000 Caucasians. As most CF patients have no family history of the disorder, carrier screening for CF has the potential to prospectively identify couples at risk of conceiving an affected child. At-risk couples may consequently choose to act on the provided information and take steps to avoid the birth of a child with CF. Although carrier screening is widely believed to enhance reproductive autonomy of prospective parents, the practice also raises important ethical questions. A written questionnaire was administered to adult patients and parents of children with CF with the aim to explore participants' attitudes toward CF carrier screening and related reproductive issues. The study population was recruited from a CF patient registry in Belgium and comprised 111 participants (64 parents, 47 patients aged 16 or older). We found that more than 80% of all participants were in favor of preconception carrier screening for CF. However, some were concerned over potential negative consequences of population-wide CF carrier screening. Regarding future reproductive intentions, 43% of the participants indicated a desire to have children. Among these, preimplantation genetic diagnosis was found to be the most preferred reproductive option, closely followed by spontaneous pregnancy and prenatal diagnosis. Although the findings of our study suggest that patients and parents of children with CF support a population-based carrier screening program for CF, they also highlight some issues deserving particular attention when implementing such a program.European Journal of Human Genetics advance online publication, 29 July 2015; doi:10.1038/ejhg.2015.160.
    European journal of human genetics: EJHG 07/2015; DOI:10.1038/ejhg.2015.160 · 4.23 Impact Factor
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    • "A life span approach to health promotion and disease prevention has been taken to improve maternal, infant and child health (Johnson et al., 2006a). The main focus of preconception health initiatives has been to encourage every woman to develop a reproductive life plan. "
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    ABSTRACT: Women are increasingly delaying conception to later years. Hormonal contraception induces artificial cyclicity, which does not, like natural cyclicity, reflect normal, physiologic ovarian behaviour. Therefore, long-term users of hormonal contraceptives, in particular, fail to derive potential diagnostic benefits from changes in menstrual cyclicity, which usually alerts patients and physicians to developing ovarian pathology. Timely diagnosis of ovarian problems is further hampered, as anti-Müllerian hormone is suppressed by hormonal contraceptives, making the accurate assessment of functional ovarian reserve more difficult. Women on long-term hormonal contraceptives who develop premature ovarian senescence at young ages, therefore, often go undiagnosed until termination of hormonal contraception, when they present with either post-contraception amenorrhea, other menstrual abnormalities or infertility. As evolving screening options now permit the detection of young women at risk for premature ovarian senescence, it is proposed that young women are offered ‘risk screening’ for premature ovarian senescence before starting long-term hormonal contraception. A potential protocol is outlined.
    Reproductive biomedicine online 08/2014; 29(5). DOI:10.1016/j.rbmo.2014.07.013 · 2.98 Impact Factor
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    • "Use of culturally and linguistically appropriate systems of care to enhance preconception health care services, with the ultimate goal of providing comprehensive evidence-based preconception health care, has also been recommended (Johnson et al., 2006). One avenue of promoting culturally appropriate preconception health care is community-based participatory research (CBPR), which was developed to increase the effectiveness of health promotion and prevention programs by involving target communities in their design, implementation, and evaluation. "
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    ABSTRACT: Sacred Beginnings is a community-based participatory research project that examines the effectiveness of a culturally appropriate preconception health educational intervention developed by tribal community members and elders. The primary goal is to increase knowledge of preconception health and its benefits among adolescent females and tribal communities. Preconception health is an area of considerable concern among American Indians (AIs) in the Northern Plains region, as there are high rates of birth, infant mortality, unintended pregnancy, teen pregnancy, and sexually transmitted diseases in this area. We examined the effectiveness of implementing this intervention during a residential summer program for AI high school students. The educational intervention consisted of 15 preconception health education sessions and was piloted during a summer high school residential academic program. The intervention (N = 39) and non-intervention (N = 38) groups were comprised of incoming AI female freshmen representing comparable demographics. A pre- and post-intervention survey was administered to both groups. Results indicated a significant difference in Time 2 (T2; post-intervention) scores, with the intervention group scoring higher than the non-intervention group in overall preconception health knowledge and obesity knowledge. In terms of intra-group score analysis between Time 1 (T1; pre-intervention) and T2, there were significant changes within the intervention group in knowledge of obesity and diabetes. Knowledge changes in smoking were approaching significance. Within the non-intervention group, there was a significant change from T1 to T2 in scores for diabetes knowledge only. The key finding was that the intervention group had higher overall preconception health knowledge at T2 compared to the non-intervention group. Intervention participants demonstrated an understanding of how preconception behaviors may affect birth outcomes and maternal health. Another key finding was that, among participants in the intervention group, the change in knowledge regarding smoking beliefs between T1 and T2 were approaching significance. Because smoking during pregnancy is a risk factor for poor birth outcomes, this finding emphasizes that future curriculum modification should address the effects of smoking, and the benefits of smoking cessation, prior to or during pregnancy. Study limitations such as small sample size, high baseline health knowledge, the need to add traditional knowledge variables, and shortened implementation timeframe reveal key areas for improvement. Possible future intervention modifications include expanding on areas that reached or approached significance, implementing the intervention over a longer period of time, identifying ways to translate traditional knowledge into quantifiable survey measures, and implementing the intervention with high-risk, reservation-based populations of AI youth.
    American Indian and Alaska native mental health research (Online) 01/2012; 19(1):154-85.
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