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


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.

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    • "It is well-known that the early life environment influences women's risk of marital childbearing (see, for example, Amato et al. (2008)), but whether and how the early life environment influences birth weight is not well-established. Health scholars have recently articulated the importance of identifying preconception factors affecting perinatal health, yet most studies continue to focus on the prenatal period, or on the twelve months leading up to conception—to the exclusion of prior life events (Johnson et al., 2006; van Dyck, 2010). This is partly due to data limitations, as birth certificate data are commonly used and do not contain this information. "
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    ABSTRACT: Marriage is a social tie associated with health advantages for adults and their children, as lower rates of preterm birth and low birth weight are observed among married women. In this study the author tested 2 competing hypotheses explaining this marriage advantage—marriage protection versus marriage selection—using a sample of recent births to single, cohabiting, and married women from the National Survey of Family Growth, 2006–2010. Propensity score matching and fixed effects regression results demonstrated support for marriage selection, as a rich set of early life selection factors account for all of the cohabiting–married disparity and part of the single–married disparity. Subsequent analyses demonstrated that prenatal smoking mediates the adjusted single–married disparity in birth weight, lending some support for the marriage protection perspective. The study's findings sharpen our understanding of why and how marriage matters for child well-being and provide insight into pre-conception and prenatal factors describing intergenerational transmissions of inequality via birth weight.
    Full-text · Article · Oct 2015 · Journal of Marriage and Family
    • "Third, it encourages women to think about what contraception method(s) will best help to attain their reproductive goals at the same time as meeting their personal requirements for a contraceptive method. In 2009, the Centers for Disease Control and Prevention (CDC)'s Recommendations to Improve Preconception Health and Health Care recommended that each woman, man, and couple be encouraged to have a reproductive life plan (Johnson et al., 2006). Since then, several other organizations have made similar recommendations, including the Title X Family Planning Programs (U.S. "
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    ABSTRACT: 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-based interventions aimed at assisting privately insured women with making contraceptive choices that are consistent with their reproductive goals. Privately insured women between the ages of 18 and 40 not intending pregnancy were randomly assigned to one of three groups: 1) a reproductive life planning (RLP) intervention, 2) a reproductive life planning enriched with contraceptive action planning (RLP+) intervention, or 3) an information only control group. Both the RLP and RLP+ guide women to identify their individualized reproductive goals and contraceptive method requirements. The RLP+ additionally includes a contraceptive action planning component, which uses if-then scenarios that allow the user to problem solve situations that make it difficult to be adherent to their contraceptive method. All three groups have access to a reproductive options library containing information about their contraceptive coverage and the attributes of alternative contraceptive methods. Women completed a baseline survey with follow-up surveys every 6 months for 2 years concurrent with intervention boosters. Study outcomes include contraceptive use and adherence. identifier: NCT02100124. Results from the MyNewOptions study will demonstrate whether web-based reproductive life planning, with or without contraceptive action planning, helps insured women make patient-centered contraceptive choices compared with an information-only control condition. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · Women s Health Issues
    • "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.
    No preview · Article · Jul 2015 · European journal of human genetics: EJHG
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