Thursday, April 5, 2012

Importance of preconception care for improving maternal, child health

Today’s National Public Health Week guest blog is by Katie Baker, MPH, doctoral candidate and research coordinator at the Skin Cancer Prevention Lab at the College of Public Health of East Tennessee State University.

In the U.S., most people are familiar with prenatal care. These services, which became popular in the 1980s, are provided to pregnant women and are meant to increase the likelihood of a healthy delivery. Despite the fact that the majority of pregnant women in the U.S. receive some sort of prenatal care, we haven’t seen the dramatic improvement in birth outcomes that many experts anticipated. This is not to say that prenatal care is ineffective; we may simply be implementing services too late.

By the time most women realize they’re pregnant and present for their first prenatal care visit, they are 11 to 12 weeks pregnant. Interestingly, some of the most critical fetal developments occur between weeks four and 10 of gestation. By focusing on reducing health risks during pregnancy, we may be ignoring risks when their impact on fetal development may be the greatest: before pregnancy. Common sense tells us that by focusing only on risk reduction during pregnancy, we have failed to address existing risks before pregnancy, when they’re likely to have the greatest impact on fetal development.

While maintaining high standards of prenatal care, we should begin shifting our focus and our resources to improving preconception health for women, men and couples. As providers and public health practitioners, we should encourage women and their partners to:

• learn about reproduction, the menstrual cycle and fertility awareness;
• learn about and get screened for sexually transmitted infections;
• create a reproductive life plan that includes both short- and long-term personal goals; a timeline detailing the optimal time to have a child while working toward those personal goals; the couple’s desired number of children; appropriate birth-spacing; and the contraceptive method(s) the couple prefers; and
• schedule a preconception health care visit at least three months before trying to get pregnant.

We must also stress that women who intend on becoming pregnant make sure their immunizations are up-to-date; focus on a healthy diet and exercise plan; stop smoking and drinking alcohol; be screened for nutritional deficiencies, such as anemia; and begin taking a daily multivitamin at least three months before they become pregnant.

For more information, download facts on preconception care from the Centers for Disease Control and Prevention (PDF) or visit the CDC website. Additional information is online via the American College of Obstetricians and Gynecologists (PDF) and

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