Transforming Preconceptional, Prenatal, and Interconceptional Care Into A Comprehensive Commitment To Women's Health

doi:10.1016/j.whi.2008.07.014

Women's Health Issues

Volume 18, Issue 6, Supplement, November–December 2008, Pages S13-S18

https://doi.org/10.1016/j.whi.2008.07.014 Get rights and content

Preconception and interconception care respond to the growing body of evidence that many of the most important determinants of birth outcomes may exist before pregnancy occurs. In this sense, the strategy of extending prenatal care into the preconception and interconception periods marks a useful step in reforming the public health approach to improving birth outcomes. However, although helpful in underscoring the continuity of risk that can ultimately find expression in adverse birth outcomes, the concern is that without greater critical attention these relatively new care constructs have the potential to undermine rather than strengthen a comprehensive system of women's health care.

Introduction

It is essential that preconception, prenatal, and interconception care not be viewed as distinct entities, but rather emphasize their inherent linkages as part of a comprehensive vision of care. The danger lies in that an uncritical, business-as-usual embrace of these separate care strategies will only serve to exacerbate the discontinuities of care in what is already one of the most highly fragmented arenas of health care in the United States. To be constructive, therefore, the definition and particularly the operationalization of preconception, prenatal, and interconception care must generate greater integration and not isolation of service delivery systems. This will require new clinical and administrative practices that respect the currents of risk and clinical capacity that flow uninterrupted through these distinct arenas of care. However, the effort to ensure that preconception, prenatal, and interconception care will ultimately support integrated, comprehensive strategies of service provision must not only attend to technical and organizational considerations, it must also speak to questions of justice. This is because programs designed to improve birth outcomes are not generated exclusively by clinical or administrative insights alone. Rather, they are also deeply rooted in the fractious political debate over the best ways to alleviate the suffering of children and a longstanding societal ambivalence over the social roles of women.

Section snippets

Background: The Marginalization and Fragmentation of Childbearing Risk

A major barrier to the adoption of a more comprehensive vision of preconception, prenatal, and interconception care is the way the science of poor birth outcomes is portrayed in the world of public policy. If nothing else, the science of poor birth outcomes has been characterized by a proliferation of studies designed to identify singular risk associations, or “risk factors,” such as teenage pregnancy, maternal illicit drug use, or the lack of prenatal care (Behrman & Butler, 2007). Although

Discussion: Constructing a Comprehensive Commitment to Women's Health

In theory, all fertile women between menarche and menopause are potentially preconceptional. Although preconception care has been a useful extension of prenatal care by recognizing that childbearing risk may predate conception, it is nevertheless an anticipatory health construct predicated on intentionality. Functionally, preconception care becomes useful only when a woman intends or at least anticipates a pregnancy. If a woman does not anticipate that she will conceive in the near term, it is

Conclusion

Preconception, prenatal, and interconception care will continue to provide useful frameworks for delivering many effective services to childbearing women. This discussion does not question the intentions or focused utility of extending a concern for newborn health to both the periods before and after pregnancy. Rather, the central premise of this discussion is that preconception, prenatal, and interconception care must be extended even further and ultimately transformed into components, albeit

Dr. Wise is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics at Stanford University School of Medicine and the Lucile Packard Children's Hospital at Stanford. He is Director of the Center for Policy, Outcomes and Prevention and a core faculty of the Centers for Health Policy and Primary Care Outcomes Research, Stanford University.

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Cited by (60)

Delivering Coordinated Cardio-Obstetric Care from Preconception through Postpartum
2021, Cardiology Clinics
Cluster Randomized Trial of a Pre/Interconception Health Intervention for Mothers in Pediatric Visits
2020, Academic Pediatrics
Recognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial.
Pediatric clinicians were randomized to a screening and brief educational intervention group or usual care comparison group. Intervention group clinicians received training on pre/interconception care, including recommended counseling and referral resources for needs identified. Women presenting to primary care with their child ≤12 months were enrolled and assigned to the group corresponding to the assignment of their child's clinician. Mothers seen by clinicians in the intervention group completed a pre/interconception health screening tool and discussed results with their child's clinician during the visit. These mothers were compared to mothers seen by comparison group clinicians who did not receive the screening tool or clinician discussion. All enrolled mothers (Intervention and Comparison) received written preconception health information and a 90-day supply of multivitamins. Primary outcomes at 6 and 12 months post enrollment included contraception use, pregnancy, and access to and use of preventive health care. Secondary outcomes included daily folic acid supplementation, smoking, and substance use.
A total of 415 women were enrolled and those who had at least 1 follow-up assessment were included in the analysis (n = 383). There was no significant effect of the intervention on contraceptive use, pregnancy incidence, or use of preventive care. Assignment to the intervention increased the odds of daily folic acid use (odds ratio 1.82, 95% confidence interval 1.25, 2.63) during follow-up. Intervention mothers were less likely to smoke at 6, but not 12 months.
Pediatric visits are an opportune location for addressing maternal health and this intervention demonstrated feasibility and improved outcomes for some but not all outcomes. Attention to maternal health needs in pediatric visits during infancy may be important for maintaining positive pre/interconception health behaviors.
Interconception Challenges of Women Who Had Prior Preterm Births
2017, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Citation Excerpt :
Health care providers can tailor questions to ensure that women's specific, individualized challenges are discussed during clinical encounters. Research designed to enroll women after a preterm birth, subsequent to hospital or early transition home care, is not often funded (Wise, 2008). This limits knowledge about challenges that affect women's everyday lives between pregnancies.
To describe the interconception challenges of women who had prior preterm births.
We used a cross-sectional design and collected data via survey.
King County, Washington.
Ninety-two women who had prior early preterm births (20–33 weeks gestation) were included.
Women were recruited from a larger study focused on exploring the infectious pathways for early preterm birth. Participants were interviewed once using open-ended and close-ended surveys. The primary open-ended survey question was What are the five greatest challenges you experience now? We analyzed data using inductive and summative content analysis and descriptive statistics.
Ninety-one participants described challenges. One participant had no challenge. We categorized 11 challenges during the interconception period: Mothering (n = 70, 76%), Self-Care Desires (n = 35, 38%), Finances (n = 31, 34%), Employment (n = 31, 34%), Partner Relationships (n = 29, 32%), Individualized Concerns (n = 25, 27%), Mental Health (n = 23, 25%), Balance (n = 22, 24%), Physical Health (n = 19, 21%), Housing (n = 18, 20%), and Family (n = 17, 19%).
Participants described an array of challenges that often related to their roles as mothers, employees, and partners. Our research advances knowledge by describing contemporary challenges of women during the interconception period.
Child Poverty and the Promise of Human Capacity: Childhood as a Foundation for Healthy Aging
2016, Academic Pediatrics
The effect of child poverty and related early life experiences on adult health outcomes and patterns of aging has become a central focus of child health research and advocacy. In this article a critical review of this proliferating literature and its relevance to child health programs and policy are presented. This literature review focused on evidence of the influence of child poverty on the major contributors to adult morbidity and mortality in the United States, the mechanisms by which these associations operate, and the implications for reforming child health programs and policies. Strong and varied evidence base documents the effect of child poverty and related early life experiences and exposures on the major threats to adult health and healthy aging. Studies using a variety of methodologies, including longitudinal and cross-sectional strategies, have reported significant findings regarding cardiovascular disorders, obesity and diabetes, certain cancers, mental health conditions, osteoporosis and fractures, and possibly dementia. These relationships can operate through alterations in fetal and infant development, stress reactivity and inflammation, the development of adverse health behaviors, the conveyance of child chronic illness into adulthood, and inadequate access to effective interventions in childhood. Although the reviewed studies document meaningful relationships between child poverty and adult outcomes, they also reveal that poverty, experiences, and behaviors in adulthood make important contributions to adult health and aging. There is strong evidence that poverty in childhood contributes significantly to adult health. Changes in the content, financing, and advocacy of current child health programs will be required to address the childhood influences on adult health and disease. Policy reforms that reduce child poverty and mitigate its developmental effects must be integrated into broader initiatives and advocacy that also attend to the health and well-being of adults.
Preconception and Prenatal Care
2016, Obstetrics: Normal and Problem Pregnancies
Interpregnancy care
2015, Seminars in Perinatology
Citation Excerpt :
Interconception care has been linked to preconception care since the latter was advanced in the 1980s and 1990s.2–6 A growing body of evidence indicated that prenatal care interventions to improve birth outcomes amounted to “too little, too late” for many women with health risks, with greater emphasis given to a life course perspective that addressed health and risks before, during, and beyond pregnancy.7,8 The evidence pointing to preconception and interconception interventions effective in improving health outcomes for women and infants was increasing.
The aim of interconception care is to provide women who have had a prior adverse pregnancy outcome with optimal care in order to reduce risks that may affect the woman׳s health and any future birth she may choose to have. National recommendations call for action, and evidence supports specific clinical interventions. The need for interconception care is documented in national and state survey and surveillance data. Chronic diseases and behavioral risks affect the health of millions of U.S. women of childbearing age. Interconception care demonstration projects have used a “disease management” approach that includes medical care and case management. The increasing use of postpartum visits, as a gateway to interconception interventions, is essential. The Affordable Care Act emphasis on preventive services and expanded health coverage for women offers new opportunities to finance interconception care. Improved and enhanced clinical practices, along with the engagement of women, in interconception care have the potential to improve birth outcomes and reduce disparities.

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: The author has no direct financial interests that might pose a conflict of interest in connection with the submitted manuscript.

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Policy and Financing Issues for Preconception and Interconception HealthTransforming Preconceptional, Prenatal, and Interconceptional Care Into A Comprehensive Commitment To Women's Health

Introduction

Section snippets

Background: The Marginalization and Fragmentation of Childbearing Risk

Discussion: Constructing a Comprehensive Commitment to Women's Health

Conclusion

Preterm birth: Causes, consequences, and prevention

Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. National Center for Health Statistics

Vital Health Statistics

National survey of the states: Policies and practices regarding drug using women

American Journal of Public Health

Mandatory testing of pregnant women and newborns: HIV, drug use and welfare policy

Ford Urban Law Journal, XXIV

Preconception and interconception health status of women who recently gave birth to a live-born infant—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004

MMWR

Policy and Financing Issues for Preconception and Interconception Health
Transforming Preconceptional, Prenatal, and Interconceptional Care Into A Comprehensive Commitment To Women's Health