Preconception Care in the Veterans Health Administration

Callegari, Lisa S.; Edmonds, Stephanie W.; Borrero, Sonya; Ryan, Ginny L.; Cusack, Caitlin M.; Zephyrin, Laurie

doi:10.1055/s-0039-1678753

Cited by 8 publications

(5 citation statements)

References 96 publications

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“…Figure 1 shows MyPath, a patient-facing web-based reproductive decision support tool that we developed to promote high-quality, person-centered discussions about reproductive needs in the Veterans Health Administration (VA). Veterans capable of pregnancy who use VA Health Care services are a highly diverse population, with nearly half identifying as racial or ethnic minoritized groups [32], and face elevated risks of adverse pregnancy and birth outcomes compared to their civilian counterparts due to a higher prevalence of medical, mental health, and psychosocial factors [33]. Drawing on our first principle (Principle 1: Interdisciplinary stakeholder-inclusive teams), MyPath development was informed by formative qualitative work to understand veterans' preferences and needs [25] and followed user-centered design principles, guided by patient, provider, and scientific expert input [34].…”

Section: Reproductive Care For Nonpregnant People With Mypathmentioning

confidence: 99%

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States

et al. 2022

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The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of “femtech,” or technology-based solutions to women’s health issues, in the public and private sectors is promising, yet these solutions are often geared toward health-literate, socioeconomically privileged, and/or relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identify and address these critical gaps in health care for people from socially and economically marginalized populations that are capable of pregnancy, as well as people with serious chronic medical conditions. These guiding principles require that such technologies: (1) include community stakeholders in the design, development, and deployment of the technology; (2) are grounded in person-centered frameworks; and (3) address health disparities as a strategy to advance health equity and improve health outcomes.

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Section: Reproductive Care For Nonpregnant People With Mypathmentioning

confidence: 99%

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States

et al. 2022

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“…One study found that patients with Hispanic ethnicity, higher parity, unintended pregnancy, or without insurance were less likely than their Caucasian counterparts to receive preconception counseling. 18 Another study of Hispanic and African American women demonstrated one-third of participants with chronic medical conditions was unaware of preconception health risks and, therefore, did not seek preconception care. 19 Health disparities affecting minority women has also been found to decrease these women's access to preconception counseling and management of preexisting conditions, directly affecting pregnancy outcomes.…”

Section: Discussionmentioning

confidence: 99%

Preconception Counseling: Identifying Ways to Improve Services

Burrows

Sheeder

Lijewski

et al. 2022

AJP Rep

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Objective The aim of this retrospective study was to evaluate the maternal conditions for which preconception services are provided and the routine services and recommendations offered through the Maternal Fetal Medicine group at the University of Colorado (CU). The study sought to determine how services and recommendations differ by maternal condition, demographics, and reproductive health history. Materials and Methods Charts of patients who received preconception counseling through the CU MFM department during 2018 were reviewed to evaluate maternal conditions and the type of counseling patients received. Patients were grouped by their referral reason and subsequently by counseling recommendations to either proceed with immediate conception, defer immediate conception pending completion of further recommendations or to not conceive. Results Of the fifty-nine patients referred to preconception counseling, 52% (n = 31) of the women were referred for maternal disease, 40% (n = 24) for infertility, 32% (n = 19) for previous poor obstetric outcomes, 30% (n = 18) for advanced maternal age and finally, 15% (n = 9) for gynecologic anatomic abnormalities. Conclusion During the initial evaluation, 58% (n = 34) of patients were determined to have no concern for immediate conception while 7% (n = 4) were ultimately advised to not conceive. Using this data, we identified areas of preconception counseling that standardization will improve by ensuring patients receive comparable services and advice.

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“…Knowing that Veteran women are a high-risk population, the VA should continue to strive to optimize preconception, postpartum, and interconception care. 46,47 This may mean aspiring beyond a single maternal care coordinator role to, for example, the provision of on-site integrated and multidisciplinary obstetrician-gynecologist and mental health care to address the unique needs and higher risks embodied by women Veterans. 30…”

Section: Health Systems Considerations and Guidance For Providers Carmentioning

confidence: 99%

Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps

Hugin

Shaw

2019

Semin Reprod Med

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In the post-9/11 era, the number of young women serving, and deploying, in the military grew rapidly; as they exit service, there is tremendous increase in reproductive-aged women Veterans. Here, we review the limited but growing research regarding Veterans' pregnancy and obstetric outcomes. U.S. women Veterans returning from deployment carry a high burden of physical and mental health conditions, and often trauma. As poor mental health is known to predict poorer maternal and infant sequelae, there are unique concerns around perinatal outcomes in Veterans. Accordingly, there is new attention to their reproductive risks and needs—evidenced by recent research and programmatic efforts within the VA. Emerging research suggests that the unique health profiles of pregnant Veterans, including prevalent posttraumatic stress disorder, predict increased risk of preterm birth, preeclampsia, and gestational diabetes. In the most contemporary large study, relying on California birth data, Veterans who relied on VA for their health care coverage were high risk, with increased rates of preeclampsia and Cesarean delivery. Additionally, Veterans' infants (compared with non-Veterans') were more likely to require NICU care. Additional research is needed to explore upstream factors leading to these poorer outcomes. Current effort to coordinate VA and non-VA care for Veteran mothers is warranted.

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Preconception Care in the Veterans Health Administration

Cited by 8 publications

References 96 publications

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States

Preconception Counseling: Identifying Ways to Improve Services

Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps

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