Public Health Officials Emphasize Preconception Care
Some public health officials are "recast[ing]" their message of prenatal care by adding what they call "preconception care," which urges all women of childbearing age to maintain physical and emotional health well in advance of pregnancy to reduce the risk of preventable birth defects and other complications, the New York Times reports (Rabin, New York Times, 11/28).
CDC in the April 21 edition of its Morbidity and Mortality Weekly Report published preconception care recommendations. Preconception care, which takes place in multiple physician visits, involves "interventions that aim to identify and modify biomedical, behavioral and social risks to a woman's health or pregnancy outcome through prevention and management, emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact," according to the recommendations (California Healthline, 5/9).
Although the recommendations were "criticized in some quarters for treating all women as though they were eternally 'prepregnant,'" some experts say that preparing for a healthy pregnancy can require behavioral changes that take months. Pregnant women usually do not have their first prenatal visit until 10 weeks to 12 weeks after conception, doctors say.
"If a birth defect is going to happen, it's already happened," Peter Bernstein, a maternal fetal medicine specialist at Montefiore Medical Center who helped write the CDC recommendations said, adding, "The most important doctor's visit may be the one that takes place before a pregnancy is conceived."
The recommendations highlight the importance of family planning and child spacing and encourage young people to develop a "reproductive life plan," the Times reports.
According to the Times, physicians have been recommending preconception care for decades but "it has never really caught on." The issue has taken on "added urgency" because of higher rates of unplanned pregnancies and low birthweights, the Times reports.
In addition, the U.S. obesity rate and number of women delaying pregnancy continues to rise, meaning that women are more likely to have high blood pressure, diabetes or prediabetes when they become pregnant, according to the Times. Some health providers say that pregnancy planning and contraceptive use are essential in preconception care and urge all doctors to counsel women of childbearing age about the possibility of pregnancy.
"It's not like we have an injection we can give someone" to prepare her for pregnancy, Hani Atrash, associate director for program development at CDC's National Center on Birth Defects and Developmental Disabilities, said. "Some of the interventions, like weight management, need time to happen," Atrash said, adding, "What we're actually talking about ... is women's health" (New York Times, 11/28).