Preconception Health Promotion Among Maryland Women

Abstract

Despite current guidelines that all reproductive age women receive preconception care (PCC), most US women do not, especially women with a prior birth. The objective of our study was to identify factors associated with receipt of PCC health promotion counseling among Maryland women and to assess whether prior birth outcome affects receipt of counseling. We analyzed Maryland pregnancy risk assessment monitoring system data for a stratified random sample of women with a live birth in 2009-2010; 3,043 women with PCC data were included in the analysis. The dependent variable was receipt of any PCC counseling, and the primary independent variable, prior pregnancy outcome (no prior live birth, term, preterm). 33.1 % of the weighted sample received PCC. Odds of PCC were similar for women with a history of prior prior preterm birth (aOR 1.00, 95 % CI 0.57-1.78) and no prior live birth, but decreased for women with a prior full term delivery (aOR 0.69, 95 % CI 0.51-0.94). They were decreased for women with unintended births (aOR 0.36, 95 % CI 0.26-0.51) and increased for women with a diagnosis of asthma (aOR 1.74, 95 % CI 1.05-2.89) or diabetes (aOR 2.79, 95 % CI 1.20-6.45), who used multivitamins (aOR 2.58, 95 % CI 1.92-3.47), and had dental cleanings (aOR 1.60, 95 % CI 1.16-2.18). Although selected preventive health behaviors and high-risk conditions were associated with PCC, most women did not receive PCC. Characterization of women who do not receive PCC health promotion counseling in Maryland may assist in efforts to enhance service delivery.

Patterns and Determinants of Preconception Health Behaviors in Iranian Women

“…Although previous studies have indicated that there is a relationship between the level of education and PCC (26,34), in this study, the educational level of women was not related to PCC behavior. Tamal et al also found no relationship between the level of education and intention to seek PCC (35).…”

“…Similarly, in the study by Connor et al, there was no relationship between pre-pregnancy care and preterm delivery or gestational diabetes (26). The lack of relationship in this study may have been due to low number of women with a history of adverse pregnancy (preterm delivery, abortion, and medical disease).…”

“…with the study of Connor et al, there was a statistically significant relationship between PCC attendance and having a dental visit (26). Lack of practicing dentists in health centers in Iran and the expense of dental care may have caused the low level of dental care during the preconception period.…”

“…Bayrami et al reported that 46.6% of Iranian women who the intention to become pregnant followed PCC (22). In a study in the United States, 33.1% of women of reproductive age carried out PCC (26). Moreover, a study in Denmark showed that almost 100% of women referred to healthcare centers to receive prenatal care as soon as their pregnancy was diagnosed (9).…”

Current practice of preconception care by primary caregivers in the Netherlands

“…[25] Other studies report the number of pregnancies exposed to PCC. [26][27][28] In our opinion, this number does not reflect implementation of PCC by caregivers because this number only reflects a part of the actual delivery of PCC. It does not include PCC received by couples who did not conceive or whom were offered PCC but did not utilize the service.…”