Maternal and Child Health Journal

, Volume 16, Issue 9, pp 1854–1861 | Cite as

Associations Between Preconception Counseling and Maternal Behaviors Before and During Pregnancy

  • Letitia Williams
  • Lauren B. Zapata
  • Denise V. D’Angelo
  • Leslie Harrison
  • Brian Morrow
Article

Abstract

Preconception counseling (PCC) is a vital component of preconception care. Through counseling, providers educate and recommend strategies to improve health and birth outcomes for women of reproductive age. The objective of our analysis was to assess the associations between receipt of PCC and positive maternal behaviors before and during pregnancy. We analyzed 2004–2008 Pregnancy Risk Assessment Monitoring System data from Maine, New Jersey, Utah, and Vermont. Multivariable logistic regression was used to investigate the associations between receipt of PCC and prepregnancy daily multivitamin consumption, first-trimester entry into prenatal care, and cessation of smoking and drinking before pregnancy among women who smoked/drank in the 2 years preceding the survey, adjusting for a wide range of maternal characteristics. Overall, 32% of women reported receipt of PCC, with particularly low rates reported among women with an unintended pregnancy (14%) and no health insurance prior to pregnancy (14%). Receipt of PCC was associated with daily prepregnancy multivitamin consumption (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 4.0, 4.7), first-trimester entry into prenatal care for women with an intended pregnancy (AOR = 2.1; 95% CI = 1.8, 2.4), and drinking cessation before pregnancy among women who drank in the 2 years preceding the survey (AOR = 1.3; 95% CI = 1.2, 1.5). PCC was associated with positive maternal behaviors that increase the likelihood of a healthy woman, pregnancy, and infant. Unfortunately, less than one-third of women with a recent live birth reported receiving PCC. These data provide population-based evidence suggesting the value of PCC in the promotion of healthy maternal behaviors for women with intended or unintended pregnancies.

Keywords

Preconception care Smoking cessation Dietary supplements/utilization Drinking behavior Prenatal care 

Notes

Acknowledgments

The authors thank the members of the PRAMS Working Group: Albert Woolbright, PhD (Alabama); Kathy Perham-Hester, MS, MPH (Alaska); Mary McGehee, PhD (Arkansas); Alyson Shupe, PhD; (Colorado); George Yocher, MS (Delaware); Marie Bailey, MA, MSW, MPH (Florida) Carol Hoban, MS, MPH (Georgia); Mark Eshima, MA (Hawaii); Theresa Sandidge, MA (Illinois); Joan Wightkin (Louisiana); Tom Patenaude (Maine); Diana Cheng, MD (Maryland); Hafsatou Diop, MD, MPH (Massachusetts); Violanda Grigorescu, MD, MSPH (Michigan); Judy Punyko, PhD, MPH (Minnesota); Marilyn Jones, MEd (Mississippi); Venkata Garikapaty, MSc, MS, PhD, MPH (Missouri);—JoAnn Dotson (Montana); Brenda Coufal (Nebraska); Lakota Kruse, MD (New Jersey); Eirian Coronado (New Mexico); Anne Radigan-Garcia (New York State); Candace Mulready-Ward, MPH (New York City); Paul Buescher, PhD (North Carolina); Sandra Anseth (North Dakota); Connie Geidenberger (Ohio); Alicia Lincoln, MSW, MSPH (Oklahoma); Kenneth Rosenberg, MD (Oregon); Tony Norwood (Pennsylvania); Sam Viner-Brown, PhD (Rhode Island); Mike Smith (South Carolina); Christine Rinki, MPH (South Dakota Tribal); Kate Sullivan, PhD (Texas); David Law, PhD (Tennessee); Laurie Baksh (Utah); Peggy Brozicevic (Vermont); Marilyn Wenner (Virginia); Linda Lohdefinck (Washington state); Melissa Baker, MA (West Virginia); Katherine Kvale, PhD (Wisconsin); Angi Crotsenberg (Wyoming); CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health.

References

  1. 1.
    American College of Obstetricians and Gynecologists. (2009). ACOG Committee Opinion no. 452: Primary and preventive care: Periodic assessments. Obsterics and Gynecology, 114(6), 1444–1451.Google Scholar
  2. 2.
    Atrash, H., Jack, B. W., Johnson, K., Coonrod, D. V., Moos, M. K., Stubblefield, P. G., et al. (2008). Where is the “W”oman in MCH? American Journal of Obstetrics and Gynecology, 199(6 Suppl 2), S259–S265.PubMedCrossRefGoogle Scholar
  3. 3.
    Moos, M. K., Dunlop, A. L., Jack, B. W., Nelson, L., Coonrod, D. V., Long, R., et al. (2008). Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. American Journal of Obstetrics and Gynecology, 199(6 Suppl 2), S280–S289.PubMedCrossRefGoogle Scholar
  4. 4.
    Berghella, V., Buchanan, E., Pereira, L., & Baxter, J. K. (2010). Preconception care. Obstetrical and Gynecological Survey, 65(2), 119–131.PubMedCrossRefGoogle Scholar
  5. 5.
    Floyd, R. L., Jack, B. W., Cefalo, R., Atrash, H., Mahoney, J., Herron, A., et al. (2008). The clinical content of preconception care: Alcohol, tobacco, and illicit drug exposures. American Journal of Obstetrics and Gynecology, 199(6 Suppl 2), S333–S339.PubMedCrossRefGoogle Scholar
  6. 6.
    Gardiner, P. M., Nelson, L., Shellhaas, C. S., Dunlop, A. L., Long, R., Andrist, S., et al. (2008). The clinical content of preconception care: Nutrition and dietary supplements. American Journal of Obstetrics and Gynecology, 199(6 Suppl 2), S345–S356.PubMedCrossRefGoogle Scholar
  7. 7.
    Jack, B. W., Atrash, H., Coonrod, D. V., Moos, M. K., O’Donnell, J., & Johnson, K. (2008). The clinical content of preconception care: An overview and preparation of this supplement. American Journal of Obstetrics and Gynecology, 199(6 Suppl 2), S266–S279.PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). 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 Recommendations and Reports, 55(RR-6), 1–23.Google Scholar
  9. 9.
    Czeizel, A. E., & Dudas, I. (1992). Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. New England Journal of Medicine, 327(26), 1832–1835.PubMedCrossRefGoogle Scholar
  10. 10.
    Lumley, J., Watson, L., Watson, M., & Bower, C. (2001). Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database of Systematic Reviews, 3, CD001056.Google Scholar
  11. 11.
    Wald, N. J. (2004). Folic acid and the prevention of neural-tube defects. New England Journal of Medicine, 350(2), 101–103.PubMedCrossRefGoogle Scholar
  12. 12.
    Wilcox, A. J., Lie, R. T., Solvoll, K., Taylor, J., McConnaughey, D. R., Abyholm, F., et al. (2007). Folic acid supplements and risk of facial clefts: National population based case-control study. British Medical Journal, 334(7591), 464.PubMedCrossRefGoogle Scholar
  13. 13.
    Andres, R. L., & Day, M. C. (2000). Perinatal complications associated with maternal tobacco use. Seminars in Neonatology, 5(3), 231–241.PubMedCrossRefGoogle Scholar
  14. 14.
    Shah, N. R., & Bracken, M. B. (2000). A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. American Journal of Obstetrics and Gynecology, 182(2), 465–472.PubMedCrossRefGoogle Scholar
  15. 15.
    Office on Smoking and Health. (2001). Women and smoking: A report of the surgeon general. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  16. 16.
    Office of the Surgeon General. (2004). The health consequences of smoking: A report of the surgeon general. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  17. 17.
    American Academy of Pediatrics Committee on Substance Abuse and Committee on Children With Disabilities. (2000). Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics, 106(2 Pt 1), 358–361.CrossRefGoogle Scholar
  18. 18.
    Floyd, R. L., Decoufle, P., & Hungerford, D. W. (1999). Alcohol use prior to pregnancy recognition. American Journal of Preventive Medicine, 17(2), 101–107.PubMedCrossRefGoogle Scholar
  19. 19.
    Lundsberg, L. S., Bracken, M. B., & Saftlas, A. F. (1997). Low-to-moderate gestational alcohol use and intrauterine growth retardation, low birthweight, and preterm delivery. Annals of Epidemiology, 7(7), 498–508.PubMedCrossRefGoogle Scholar
  20. 20.
    Sokol, R. J., Delaney-Black, V., & Nordstrom, B. (2003). Fetal alcohol spectrum disorder. Journal of the American Medical Association, 290(22), 2996–2999.PubMedCrossRefGoogle Scholar
  21. 21.
    Windham, G. C., Von Behren, J., Fenster, L., Schaefer, C., & Swan, S. H. (1997). Moderate maternal alcohol consumption and risk of spontaneous abortion. Epidemiology, 8(5), 509–514.PubMedCrossRefGoogle Scholar
  22. 22.
    Tong, V. T., England, L. J., Dietz, P. M., & Asare, L. A. (2008). Smoking patterns and use of cessation interventions during pregnancy. American Journal of Preventive Medicine, 35(4), 327–333.PubMedCrossRefGoogle Scholar
  23. 23.
    American College of Obstetricians and Gynecologists. (2005). ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women’s health care. Obstetrics and Gynecology, 106(3), 665–666.CrossRefGoogle Scholar
  24. 24.
    Freda, M. C., Moos, M. K., & Curtis, M. (2006). The history of preconception care: Evolving guidelines and standards. Maternal and Child Health Journal, 10(5 Suppl), S43–S52.PubMedCrossRefGoogle Scholar
  25. 25.
    Gilstrap, L. C., & Oh, W. (Eds.). (2002). Guidelines for perinatal care (5th ed.). Elk Grove Village, IL: American Academy of Pediatrics.Google Scholar
  26. 26.
    Moos, M. K., & Wieczorek, R. R. (2003). Preconception health promotion: A focus for women’s wellness. White Plains, NY: March of Dimes.Google Scholar
  27. 27.
    Cena, E. R., Joy, A. B., Heneman, K., Espinosa-Hall, G., Garcia, L., Schneider, C., et al. (2008). Learner-centered nutrition education improves folate intake and food-related behaviors in nonpregnant, low-income women of childbearing age. Journal of the American Dietetic Association, 108(10), 1627–1635.PubMedCrossRefGoogle Scholar
  28. 28.
    Clinical Practice Guideline Treating Tobacco Use Dependence 2008 Update Panel. (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. American Journal of Preventive Medicine, 35(2), 158–176.CrossRefGoogle Scholar
  29. 29.
    Goldstein, M. G., Whitlock, E. P., DePue, J., & the Planning Committee of Addressing Multiple Behavioral Risk Factors in Primary Care Project. (2004). Multiple behavioral risk factor interventions in primary care. Summary of research evidence. American Journal of Preventive Medicine, 27(2 Suppl), 61–79.PubMedCrossRefGoogle Scholar
  30. 30.
    Ranney, L., Melvin, C., Lux, L., McClain, E., Morgan, L., & Lohr, K. (2006). Tobacco use: Prevention, cessation, and control. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  31. 31.
    Robbins, J. M., Cleves, M. A., Collins, H. B., Andrews, N., Smith, L. N., & Hobbs, C. A. (2005). Randomized trial of a physician-based intervention to increase the use of folic acid supplements among women. American Journal of Obstetrics and Gynecology, 192(4), 1126–1132.PubMedCrossRefGoogle Scholar
  32. 32.
    Schwarz, E. B., Sobota, M., Gonzales, R., & Gerbert, B. (2008). Computerized counseling for folate knowledge and use: A randomized controlled trial. American Journal of Preventive Medicine, 35(6), 568–571.PubMedCrossRefGoogle Scholar
  33. 33.
    Watson, M. J., Watson, L. F., Bell, R. J., Halliday, J. L., Burford, N., & Brennecke, S. P. (1999). A randomized community intervention trial to increase awareness and knowledge of the role of periconceptional folate in women of child-bearing age. Health Expectations, 2(4), 255–265.PubMedCrossRefGoogle Scholar
  34. 34.
    Whitlock, E. P., Green, C. A., Polen, M. R., Berg, A., Klein, J., Siu, A., et al. (2004). Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  35. 35.
    Elsinga, J., de Jong-Potjer, L. C., e Bruin, K. M., le Cessie, S., Assendelft, W. J., & Buitendijk, S. E. (2008). The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy. Womens Health Issues, 18(6 Suppl), S117–S125.PubMedCrossRefGoogle Scholar
  36. 36.
    Floyd, R. L., Sobell, M., Velasquez, M. M., Ingersoll, K., Nettleman, M., Sobell, L., et al. (2007). Preventing alcohol-exposed pregnancies: A randomized controlled trial. American Journal of Preventive Medicine, 32(1), 1–10.PubMedCrossRefGoogle Scholar
  37. 37.
    Hood, K. K. (2010). Preconception counseling for adolescent females with type 1 diabetes: The READY-girls program. Current Diabetes Reports, 10(6), 393–395.PubMedCrossRefGoogle Scholar
  38. 38.
    Manwell, L. B., Fleming, M. F., Mundt, M. P., Stauffacher, E. A., & Barry, K. L. (2000). Treatment of problem alcohol use in women of childbearing age: Results of a brief intervention trial. Alcoholism, Clinical and Experimental Research, 24(10), 1517–1524.PubMedCrossRefGoogle Scholar
  39. 39.
    Temple, R. C., Aldridge, V. J., & Murphy, H. R. (2006). Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care, 29(8), 1744–1749.PubMedCrossRefGoogle Scholar
  40. 40.
    Tripathi, A., Rankin, J., Aarvold, J., Chandler, C., & Bell, R. (2010). Preconception counseling in women with diabetes: A population-based study in the north of England. Diabetes Care, 33(3), 586–588.PubMedCrossRefGoogle Scholar
  41. 41.
    Shulman, H. B., Gilbert, B. C., & Lansky, A. (2006). The pregnancy risk assessment monitoring system (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74–83.PubMedGoogle Scholar
  42. 42.
    Frey, K. A., & Files, J. A. (2006). Preconception healthcare: What women know and believe. Maternal and Child Health Journal, 10(5 Suppl), S73–S77.PubMedCrossRefGoogle Scholar
  43. 43.
    Hillemeier, M. M., Weisman, C. S., Chase, G. A., Dyer, A. M., & Shaffer, M. L. (2008). Women’s preconceptional health and use of health services: Implications for preconception care. Health Services Research, 43(1 Pt 1), 54–75.PubMedGoogle Scholar
  44. 44.
    Hosli, E. J., Elsinga, J., Buitendijk, S. E., Assendelft, W. J., & van der Pal-de Bruin, K. M. (2008). Women’s motives for not participating in preconception counseling: Qualitative study. Community Genetics, 11(3), 166–170.PubMedCrossRefGoogle Scholar
  45. 45.
    Bronstein, J. M., Felix, H. C., Bursac, Z., Stewart, M. K., Foushee, H. R., & Klapow, J. (2011). Providing general and preconception health care to low income women in family planning settings: Perception of providers and clients. Maternal and Child Health Journal. doi: 10.1007/s10995-011-0744-6.
  46. 46.
    Morgan, M. A., Hawks, D., Zinberg, S., & Schulkin, J. (2006). What obstetrician-gynecologists think of preconception care. Maternal and Child Health Journal, 10(5 Suppl), S59–S65.PubMedCrossRefGoogle Scholar
  47. 47.
    Wilensky, S., & Proser, M. (2008). Community approaches to women’s health: Delivering preconception care in a Community Health Center model. Womens Health Issues, 18(6 Suppl), S52–S60.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • Letitia Williams
    • 1
  • Lauren B. Zapata
    • 1
  • Denise V. D’Angelo
    • 1
  • Leslie Harrison
    • 1
  • Brian Morrow
    • 1
  1. 1.Division of Reproductive HealthCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations