Women Receiving Optimal Medical Help Prior to Pregnancy
Preterm and low weight births are increasing in the US, despite increasing use of prenatal care services. CHCPR researcher Marianne Hillemeier and her colleagues believe that women's health before pregnancy may be an important factor influencing this trend. The first three months of pregnancy are often the most important for fetal development. However, many risk factors involve the woman's health and behaviors before the pregnancy, and others cannot be optimally treated after the woman has conceived. Unfortunately, few women receive the counseling and care they need in the months just prior to and very early in pregnancy.
Marianne Hillemeier
Explains Hillemeier, an assistant professor of health policy and administration in the College of Health and Human Development, "though we know a lot about risk factors for poor pregnancy outcomes, there are few studies directly linking pre-pregnancy health with pregnancy outcomes." Fully one half of all pregnancies in the United States are unintended, which suggests that many women are not optimizing their health for a potential pregnancy. Hillemeier and her colleagues, Carol Weisman and Gary Chase, professors of public health sciences in the College of Medicine, report this month in Health Services Research that only one half of women at risk for becoming pregnant received any pre pregnancy counseling.
The researchers analyzed data from the Central Pennsylvania Women's Health Study (CePAWHS), a survey of reproductive age women in Pennsylvania. Participants in the study were asked about their health status and the health services they received prior to and during their pregnancies. Only half of the respondents reported that they had received any counseling or information from their health care provider on either planning for pregnancy or birth control.
The reasons for the lack of pregnancy counseling are varied. Says Hillemeier, "I think we all assumed that factors such as socio economic status would affect individuals getting timely pregnancy counseling and services. An interesting finding in our study was that so many women of reproductive age do not see an obstetrician/gynecologist." Prior to the first child, women are "more likely to see general practitioners or specialists for chronic illnesses," explains Hillemeier. With second children, women are actually most likely to spend time in pediatricians' offices. Adds Hillemeier, "Those venues may be important for reaching women in need of pre-pregnancy counseling."
Based on the survey results, the researchers are currently testing an approach to address pregnancy counseling needs by providing educational programs to women "at risk" for poor pregnancy outcomes. Says Hillemeier, "We need to raise women's awareness of the need for pre-pregnancy care." Some of the most serious birth defects and pregnancy issues occur early in pregnancy--often before women are necessarily aware of their pregnancy status and some of these conditions can be prevented with proper pre and early pregnancy care. Adds Hillemeier, "Acts as simple as taking a multivitamin prior to pregnancy can have a significant effect on pregnancy outcomes."
The paper is available at http://www.blackwell-synergy.com/loi/HESR.