Toward Improving the Outcome of Pregnancy III - March of Dimes

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Quality Improvement Opportunities in Preconception and Interconception Care Appendices Goals for Preconception Health Care 1 Goal 1: Improve the knowledge, attitudes and behaviors of men and women related to preconception health. Goal 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. Goal 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. Goal 4: Reduce the disparities in adverse pregnancy outcome. CDC Preconception Health and Health Care Recommendations1 1. Individual Responsibility Across the Lifespan. Each woman, man and couple should be encouraged to have a reproductive life plan. 2. Consumer Awareness. Increase public awareness of the importance of preconception health behaviors and preconception care services by using information and tools appropriate across various ages; literacy, including health literacy; and cultural/linguistic contexts. 3. Preventive Visits. As a part of primary care visits, provide risk assessment and educational and health promotion counseling to all women of childbearing age to reduce reproductive risks and improve pregnancy outcomes. 4. Interventions for Identified Risks. Increase the proportion of women who receive interventions as follow-up to preconception risk screening, focusing on high priority interventions (i.e., those with evidence of effectiveness and greatest potential impact). 5. Interconception Care. Use the interconception period to provide additional intensive interventions to women who have had a previous pregnancy that ended in an adverse outcome (i.e., infant death, fetal loss, birth defects, low birthweight or preterm birth). 6. Preconception Checkup. Offer, as a component of maternity care, one preconception visit for couples and persons planning a pregnancy. 7. Health Insurance Coverage for Women with Low Incomes. Increase public and private health insurance coverage for women with low incomes to improve access to preventive women’s health and preconception and interconception care. 8. Public Health Programs and Strategies. Integrate components of preconception health into existing local public health and related programs, including emphasis on interconception interventions for women with previous adverse outcomes. 9. Research. Increase the evidence base and promote the use of the evidence to improve preconception health. 10. Monitoring Improvements. Maximize public health surveillance of preconception health and related research mechanisms. 52 marchofdimes.com Toward Improving the Outcome of Pregnancy III
References 1. Johnson K, Posner SF, Biermann J, et al. 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. MMWR Recomm Rep 2006;55:1-23. 2. Atrash H, Jack BW, Johnson K, et al. Where is the “W”oman in MCH? Am J Obstet Gynecol 2008;199:S259-65. 3. Walker LO, Tinkle MB. Toward an integrative science of women’s health. J Obstet Gynecol Neonatal Nurs 1996;25:379-82. 4. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J 2003;7:13-30. 5. Ad Hoc Committee on Reproductive Life Planning of CDC Select Panel on Preconception Health and Health Care. 2009. 6. Moos MK. From concept to practice: reflections on the preconception health agenda. J Womens Health (Larchmt) 2010;19:561-7. 7. Maternal and Child Health Journal 10(5), 2006. 8. Women’s Health Issues 18(6), 2008. 9. Jack BW, Atrash H, Coonrod DV, Moos MK, O’Donnell J, Johnson K. The clinical content of preconception care: an overview and preparation of this supplement. Am J Obstet Gynecol 2008;199:S266-79. 10. Badura M, Johnson K, Hench K, Reyes M. Healthy start lessons learned on interconception care. Womens Health Issues 2008;18:S61-6. 11. California Department of Health. Preconception Health Council of California. Every Woman California. 2009;2010. 12. The Commonwealth Fund and the Centers for Disease Control and Prevention’s (CDC) Preconception Health and Health Care Initiative. Improving Primary and Interconception Care for Women in Medicaid: Peer-to-Peer (P2P) Learning for State Agencies. 2010. 13. Every Woman Southeast. 2010. www.everywomansoutheast.com 14. LA Best Babies Network. 2010. www.labestbabies.org 15. Biermann J, Dunlop AL, Brady C, Dubin C, Brann A,Jr. Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Matern Child Health J 2006;10:S21-8. 16. Livingood WC, Brady C, Pierce K, Atrash H, Hou T, Bryant T, 3rd. Impact of preconception health care: evaluation of a social determinants focused intervention. Matern Child Health J 2010;14:382-91. 17. Texas Department of State Health Services. WIC Wellness Works. 2010. 18. Broussard DL, Sappenfield WB, Fussman C, Kroelinger CD, Grigorescu V. Core State Preconception Health Indicators: A Voluntary, Multi-state Selection Process. Matern Child Health J 2010. 19. The Pennsylvania State University. Community and Child Health Network. 2010. www.communitychildhealthnetwork.org 20. Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can 2006;28:680-9. 21. Centers for Disease Control and Prevention (CDC). Use of supplements containing folic acid among women of childbearing age — United States, 2007. MMWR Morb Mortal Wkly Rep 2008;57:5-8. Quality Improvement Opportunities in Preconception and Interconception Care Toward Improving the Outcome of Pregnancy III marchofdimes.com 53
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December 2010 Toward Improving the
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Toward Improving the Outcome of Pre
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Preface: View from the Chair After
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The contents of this monograph and
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Authors Mark R. Chassin, MD, FACP,
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Authors Stephen D. Ratcliffe, MD, M
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Executive Summary Ultimately, reach
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Foreword Dimes NICU Family Support
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“Of all the forms of inequality,
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Quality Improvement Opportunities t
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Systems Change Across the Continuum
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Policy Dimensions of Systems Change
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Opportunities for Action and Summar
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National Office 1275 Mamaroneck Ave
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