Merry-K Moos

• University of North Carolina at Chapel Hill

Context: Although reproductive life planning (RLP) is recommended in federal and clinical guidelines and may help insured women make personalized contraceptive choices, it has not been systematically evaluated for effectiveness. Methods: In 2014, some 984 privately insured women aged 18-40 who were not intending to become pregnant in the next ye...

Introduction Unintended pregnancy has been a concerning public health problem for decades. As we begin to understand the complexities of pregnancy intention and how women experience these pregnancies, reproductive life planning offers a paradigm shift. Methods Reproductive life planning is a patient-centered approach that places a patient’s reprodu...

Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care sys...

The Affordable Care Act mandates that most women of reproductive age with private health insurance have full contraceptive coverage with no out-of-pocket costs, creating an actionable time for women to evaluate their contraceptive choices without cost considerations. The MyNewOptions study is a three-arm, randomized, controlled trial testing web-ba...

Background: Cardiovascular disease (CVD) screening in Title X settings can identify low-income women at risk of future chronic disease. This study examines follow-up related to newly identified CVD risk factors in a Title X setting. Methods: Female patients at a North Carolina Title X clinic were screened for CVD risk factors (n=462) and 167/462...

Objective: To review the pharmacist's role in preconception health. Data sources: PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines. Data synthesis: Preconception health has become recognized as an im...

Racial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children. The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority. Therefore, the authors conducted a study to assess and compare maternal oral health knowledg...

Fertility intentionsthe desire for and desired timing of childbearingare important drivers of reproductive health behaviors and outcomes such as unintended pregnancy. Predicting fertility is essential for family planning programs and researchers. Previous research has identified factors associated with fertility intentions however; prediction of pr...

In 2006, the Centers for Disease Control and Prevention (CDC) published recommendations to impact poor pregnancy outcomes by addressing the health status of women and men before conception. While the theoretical advantages of preconceptional health promotion grow, the actual effectiveness of preconception interventions is largely untested as are th...

Daily oral hygiene and regular dental visits are important components of oral health care. The authors' objective in this study was to examine women's oral hygiene practices and use of dental services during pregnancy. The authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic inf...

To explore the association between healthcare provider advice about weight loss and physical activity in the postpartum period and weight retention and activity levels in women assessed at 3 months postpartum. Using data from a prospective cohort study, we explored the association of advice with postpartum weight retention and activity levels in 68...

Interest in preconceptional healthcare was advanced by release of the recommendations of the Centers for Disease Control and Prevention (CDC) and its Select Panel on Preconception Care in 2006. With increasing interest, apprehension surfaced from healthcare professionals, women, and the public at large. The most common themes of concerns are that a...

This systematic review focuses on outcomes of gestational weight gain, specifically birthweight, fetal growth, and postpartum weight retention, for singleton pregnancies with respect to the 1990 Institute of Medicine weight gain recommendations. A total of 35 studies met the inclusion criteria and were reviewed. There was strong evidence to support...

Objectives: We have previously reported an association between maternal periodontal disease and preterm birth. The objective of this study was to determine oral health behavior/practice among pregnant women and to identify groups who may benefit from oral health behavior education. Methods: A written, validated questionnaire designed to assess ma...

Objectives: We have previously reported an association between maternal periodontal disease and preterm birth. The objective of this study was to determine oral health knowledge and beliefs among pregnant women and to identify groups who may benefit from oral health education in an effort to reduce periodontal disease-associated pregnancy morbidity...

Scientific evidence indicates that improving a woman's health before pregnancy will improve pregnancy outcomes. However, for many years, our efforts have focused primarily on prenatal care and on caring for infants after birth. The concept of preconception care has been identified repeatedly as a priority for improving maternal and infant health. P...

By addressing the reproductive intentions and contraceptive practices and needs of every patient, providers may be able to decrease women's chances of experiencing unintended pregnancies and support women in achieving planned and well-timed pregnancies. By addressing the health promotion needs of every patient and examining and addressing her healt...

In June 2005, the Select Panel on Preconception Care established implementation workgroups in 5 areas (clinical, public health, consumer, policy and finance, and research and surveillance) to develop strategies for the implementation of the Centers for Disease Control and Prevention recommendations on preconception health and healthcare. In June 20...

Physical activity generally declines during pregnancy, but barriers to activity during this time period are not well understood. The objective was to examine barriers to physical activity in a large cohort of pregnant women and to explore these barriers in more depth with qualitative data derived from a separate focus group study using a socioecolo...

The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on outcomes of gestational weight gain and their confounders and effect modifiers, outcomes of weight gain within or outside the 1990 Institute of Medicine (IOM) guidelines, risks and benefits of weight gai...

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preco...

Prenatal care is a venerable tradition in the U.S. health care system and one that deserves critical examination. Inordinate amounts of public and personal resources are expended on a tradition of care that has not proven itself equal to current perinatal prevention challenges. In this article, the evolution of prenatal care is reviewed, its effica...

Every locale in the United States is covered by a public health entity, generally known as the local health department, which is an arm of local, state, and federal governments, and is designed to protect, promote, and preserve the health of the population. To meet these responsibilities, health departments often become providers of personal health...

Pre-term labor and premature birth have been major concerns for nurses working in obstetric and neonatal practices for decades. The concern is well placed as more than 460,000 pre-term infants are born annually in the U.S. representing nearly one in eight births. Many strategies to stop premature contractions and thus prevent premature births have...

Preconceptional health promotion is a proven strategy to impact reproductive outcomes. Despite energy to incorporate this prevention strategy into the care of women in this country, little evidence exists that the paradigm shift necessary to reframe the clinical care of women has occurred or that public awareness about critical opportunities for pr...

Preconceptional health promotion should not be approached as an isolated activity. Instead, a new approach to women's wellness is needed. Rather than targeting care to women based on their pregnancy status or desires, health promotion and disease prevention should be integrated into a continuum of care throughout the life cycle. When care for women...

Unintended pregnancies account for about half of all pregnancies in the United States and, in 1995, numbered nearly 3 million pregnancies. They pose appreciable medical, emotional, social and financial costs on women, their families and society. The US is not attaining national goals to decrease unintended pregnancies, and little is known about eff...

This study validated a measure of pregnancy planning effort based on Miller's conceptual framework in two clinical settings. The questionnaire's main items deal with general behaviour with regard to pregnancy, timing and proception (proception being the reverse of contraception). Values for these three items are added to yield a continuous score ra...

Unintended pregnancies occur in all age groups and socioeconomic strata of our society and represent significant social, medical, and economic costs. Nearly 50% of all pregnancies in the United States are classified as unintended, and approximately 48% of all women ages 15 to 44 have experienced at least one unintended pregnancy. Contributors to un...

To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or...

Objective: To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. Methods: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine f...

Traditional implementation of clinical information systems follows a predictable project management process. The selection, development, implementation, and evaluation of the system and the project management aspects of those phases require considerable time and effort. The purpose of this paper is to describe the beta site implementation of a know...

PIP Women in the US experience high rates of unintended pregnancy compared with women from other countries. It is estimated that nearly 50% of pregnancies are unintended. About 66% of these pregnancies occur in adult women and 30% occur within marriage. In considering this fact, it is reasonable to explore how women's health care providers¿ influen...

PIP This study examined whether intendedness is a valued characteristic of pregnancy and what factors influence women to risk unintended (unwanted or mistimed) pregnancy. Study participants were 24-34 weeks pregnant, White or Black, aged 18-30, and receiving prenatal care from a publicly funded clinic in North Carolina. Information gathered from 8...

This article of the past and current measures of unintendedness of pregnancy has been offered in the hope that investigation into this area can be expanded. Current information available from available national surveys is not comparable due to different survey questions, inclusion criteria, and timing of interviews. What are often reported as rates...

The objective for this study was to determine whether a brief preconceptional health promotion program for low-income women attending family planning clinics impacts on intendedness of pregnancy. In this prospective study, we examined data on 1378 women presenting for prenatal care at three local health departments. Each of the departments offers a...

The pregnancies of black women are complicated by adverse outcomes such as prematurity and low birth weight at twice the rate of complications in pregnancies of white women. Although the cause of this racial disparity is unknown, it is most likely multifactorial. The disparity in outcomes has been found in many studies despite implementation of con...

Preconceptional health promotion should provide a prevention framework for interactions with all women of childbearing potential. Preconceptional counselling is properly directed by specialists in the field of obstetrics and gynaecology, but a multispecialty effort may be needed to achieve adequate information for decision-making. Preconceptional h...

Preconception care allows the obstetrician-gynecologist to provide primary prevention services. A growing body of evidence indicates that damage may be done to the fetus during the period of organogenesis, days 17-56 after fertilization; most patients enter prenatal care well beyond that time. Multiple disease processes, nutritional imbalances, and...

Our purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers. In 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals. Cultures were obtained from the lower...

This national survey of Fellows of The American College of Obstetricians and Gynecologists found that obstetrician/gynecologists are actively involved in continuing medical education activities and appear satisfied with the resources available, yet desire additional opportunities for lifelong learning. Traditional resources (eg, journals, seminars)...

Efforts to prevent perinatal mortality and morbidity are traditionally directed at the pregnant woman. It is during the prenatal period that the mother's health status is closely monitored; her exposure to substances known to be harmful to the fetus is assessed, and intensive patient education on behaviors likely to benefit the unborn child is offe...

Women contemplating pregnancy generally dream of a healthy infant yet are unaware of the critical significance of the weeks of organogenesis that precede entry into prenatal care. Programs of preconceptional health promotion provide women with information on the potential relatedness of prepregnancy lifestyle choices, health status, and pregnancy o...

A case is presented of intrauterine cytomegalovirus infection. Initially, the infection was most probably manifested by elevated second trimester maternal serum alpha-fetoprotein levels. Placental involvement by the infectious agent may have produced the elevations in maternal serum. Alpha-fetoprotein elevation unrelated to fetal anatomic abnormali...

The extent to which public health agencies and experts may participate in determining and implementing policies and in distributing funds deserves close scrutiny. Historically, state boards of health have been one instrument for formulating public health policy and budgets. In 1972, all but four states were served by a public health board; forty of...

Fifteen local health departments that were identified as notable for their involvement in rendering personal health care were intensively studied along with their communities. Interviews with local medical care leaders and practitioners provided much of the study data. Three patterns characterized the relationships between the health departments an...

Many people (40 per cent) receive each year some personal health service provided by local health departments. A substantial number of poor children (50 per cent) look to public agencies including health departments for all or part of their medical care. A number of departments including those represented in this study come close to serving as the...