Skip to main content

Preconception Health Promotion Among Maryland Women

Maternal and Child Health Journal volume 18, pages 2437–2445 (2014)Cite this article

Abstract

Despite current guidelines that all reproductive age women receive preconception care (PCC), most US women do not, especially women with a prior birth. The objective of our study was to identify factors associated with receipt of PCC health promotion counseling among Maryland women and to assess whether prior birth outcome affects receipt of counseling. We analyzed Maryland pregnancy risk assessment monitoring system data for a stratified random sample of women with a live birth in 2009–2010; 3,043 women with PCC data were included in the analysis. The dependent variable was receipt of any PCC counseling, and the primary independent variable, prior pregnancy outcome (no prior live birth, term, preterm). 33.1 % of the weighted sample received PCC. Odds of PCC were similar for women with a history of prior prior preterm birth (aOR 1.00, 95 % CI 0.57–1.78) and no prior live birth, but decreased for women with a prior full term delivery (aOR 0.69, 95 % CI 0.51–0.94). They were decreased for women with unintended births (aOR 0.36, 95 % CI 0.26–0.51) and increased for women with a diagnosis of asthma (aOR 1.74, 95 % CI 1.05–2.89) or diabetes (aOR 2.79, 95 % CI 1.20–6.45), who used multivitamins (aOR 2.58, 95 % CI 1.92–3.47), and had dental cleanings (aOR 1.60, 95 % CI 1.16–2.18). Although selected preventive health behaviors and high-risk conditions were associated with PCC, most women did not receive PCC. Characterization of women who do not receive PCC health promotion counseling in Maryland may assist in efforts to enhance service delivery.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Fine, A., & Kotelchuk, M. (2010). Rethinking MCH: The MCH life course model as an organizing framework. U.S. DHHS, HRSA, Maternal and Child Health Bureau. Accessed Nov 6, 2012 from http://mchb.hrsa.gov/lifecourse/rethinkingmchlifecourse.pdf.

  2. Goldenberg, R. L., & Culhane, J. F. (2005). Prepregnancy health status and the risk of preterm delivery. Archives of Pediatrics and Adolescent Medicine, 159(1), 89–90.

    PubMed  Article  Google Scholar 

  3. Cheng, T. L., Kotelchuck, M., & Guyer, B. (2012). Preconception women’s health and pediatrics: An opportunity to address infant mortality and family health. Academic Pediatric, 12(5), 357–359.

    Article  Google Scholar 

  4. Ehrenthal, D. B., et al. (2013). Independent relation of maternal prenatal factors to early childhood obesity in the offspring. Obstetrics and Gynecology, 121, 115–121.

    PubMed  Google Scholar 

  5. D’Angelo, D., Williams, L., Morrow, B., et al. (2007). 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. Morbidity and Mortality Weekly Report, 56(SS10), 1–35.

    Google Scholar 

  6. Denny, C. H., et al. (2012). Racial and ethnic disparities in preconception risk factors and preconception care. Journal of Women’s Health, 21(7), 720–729.

    PubMed  Article  Google Scholar 

  7. Johnson, K., Posner, S. F., Biermann, J., et al. (2006). Recommendations to improve preconception health and health care: United States. Morbidity and Mortality Weekly Report, 55(RR06), 1–23.

    Google Scholar 

  8. Jack, B. W., Atrash, H., Coonrod, D. V., et al. (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.

    PubMed  Article  Google Scholar 

  9. Lu, M. C., Kotelchuck, M., Culhane, J. F., et al. (2006). Preconception care between pregnancies: The content of internatal care. Maternal and Child Health Journal, 10(5 Suppl), S107–S122.

    PubMed  Article  Google Scholar 

  10. American College of Obstetricians and Gynecologists. (1996). Guidelines for women’s health care (2nd ed.). Washington, DC: American College of Obstetricians and Gynecologists.

    Google Scholar 

  11. Moos, M. K., Dunlop, A. L., Jack, B. W., 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.

    PubMed  Article  Google Scholar 

  12. Board on Population Health and Public Health Practice, Institute of Medicine. (2011). Clinical preventive services for women: Closing the gaps. Washington, DC: The National Academies Press.

    Google Scholar 

  13. Centers for Disease Control and Prevention. (2013). My reproductive life plan. Accessed Dec 22, 2013 from http://www.cdc.gov/preconception/reproductiveplan.html.

  14. Strobino, D., O’Campo, P., & Schoendorf, K. C. (1995). A strategic framework for infant mortality reduction: Implications for healthy start. Milbank Quarterly, 73(4), 507–533.

    CAS  PubMed  Article  Google Scholar 

  15. Kantrowitz-Gordon, I. (2013). Expanded care for women and families after preterm birth. Journal of Midwifery & Women’s Health, 58, 158–166.

    Article  Google Scholar 

  16. Henderson, J. T., Weisman, C. S., & Grason, H. (2002). Are two doctors better than one? Women’s physician use and appropriate care. Womens Health, 12(3), 138–149.

    Google Scholar 

  17. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (2012). Healthy people 2020. Washington, DC: Maternal, infant, and child health objectives. Accessed Nov 6, 2012 from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26.

  18. Cheng, D., Fox, R. E., & Guyer, B., et al. The Maryland Infant Mortality Epidemiology Workgroup. (2011). Maryland infant mortality epidemiology work group findings from data analysis and overall recommendations. Project Report. Maryland Department of Health and Mental Hygiene. Accessed Dec 4, 2012 from http://health-equity.pitt.edu/3160/1/IM_Epi_Work_Group__Report_Final_Aug_24_2011.pdf.

  19. Lorenz, D., Lincoln, A., Dooley, S., et al. (2007). Surveillance of preconception health indicators among women delivering live-born infants: Oklahoma, 2000–2003. Morbidity and Mortality Weekly Report, 56(25), 631–634.

    Google Scholar 

  20. Williams, L., et al. (2012). Associations between preconception counseling and maternal behaviors before and during pregnancy. Maternal and Child Health Journal, 16, 1854–1861.

    PubMed  Article  Google Scholar 

  21. PRAMS Team. (2012). Maryland PRAMS report 2010 births. Maryland Department of Health and Mental Hygiene, Center for Maternal & Child Health and Vital Statistics Administration. Accessed Nov 6, 2012 from http://fha.maryland.gov/pdf/mch/MarylandPRAMSReport2010Births.pdf.

  22. Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.

    PubMed  Article  Google Scholar 

  23. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.

    CAS  PubMed Central  PubMed  Google Scholar 

  24. Damas, K. (2008). Prevention of preterm birth: A renewed national priority. Current Opinion in Obstetrics and Gynecology, 20, 590–596.

    Article  Google Scholar 

  25. Stata Corporation. (2009). Stata statistical software: Release 9.0. College Station, TX: Stata Corporation.

    Google Scholar 

  26. Squiers, L., et al. (2013). Consumers’ perceptions of preconception health. American Journal of Health Promotion, 3S, S10–S19.

    Article  Google Scholar 

  27. Hussaini, K. S., Hamm, E., & Means, T. (2012). Using community-based participatory mixed methods research to understand preconception health in African American communities of Arizona. Maternal and Child Health Journal.

  28. Mazza, D., & Chapman, A. (2010). Improving uptake of preconception care and periconceptional folate supplementation: What do women think? BMC Public Health, 10, 786–791.

    PubMed Central  PubMed  Article  Google Scholar 

  29. Raglan, G. B. et al. (2013). Obstetrics and gynecology practices and patient insurance type. Women’s Health Issues, 23(3), e1–e5.

    Google Scholar 

  30. Kukreja, R., et al. (2012). Knowledge of preconception health care among primary care physicians in Delaware. Delaware Medical Journal, 11, 349–352.

    Google Scholar 

  31. Mitchell, E. W., Levis, D. M., & Prue, C. E. (2012). Preconception health: Awareness, planning, and communication among a sample of US men and women. Maternal and Child Health Journal, 16, 31–39.

    PubMed  Article  Google Scholar 

  32. DeVoe, J. E., Tillotson, C. J., Wallace, L. S., et al. (2011). Parent and child usual source of care and children’s receipt of health care services. The Annals of Family Medicine, 9(6), 504–513.

    Article  Google Scholar 

  33. Wade, G. H., Herman, J., & McBeth, Snyder L. (2012). A preconception care program for women in a college setting. MCN: The American Journal of Maternal Child Nursing, 37(3), 164–170.

    Google Scholar 

  34. Wise, P. H. (2008). Transforming preconceptional, prenatal, and interconceptional care into a comprehensive commitment to women’s health. Women’s Health Issues, 18S, S13–S18.

    Article  Google Scholar 

  35. Lu, M. C. (2010). Healthcare reform and women’s health: A life-course perspective. Current Opinion in Obstetrics and Gynecology, 22, 487–491.

    PubMed  Article  Google Scholar 

  36. Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics.

    Google Scholar 

  37. Johnson, K. (2012). Issue brief: Addressing women’s health needs and improving birth outcomes—results from a peer-to-peer state Medicaid learning project. The Commonwealth Fund, 1620, 21.

    Google Scholar 

  38. Pies, C., Parthasarathy, P., & Posner, S. F. (2012). Integrating the life course perspectives into a local maternal and child health program. Maternal and Child Health Journal, 16(3), 649–655.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

During the time that this work was completed, Dr. Connor was supported by the following training Grant: AHRQ/NRSA T32 HS 017596 (PI: Anne Duggan, ScD).

Author information

Affiliations

  1. The Herman and Walter Samuelson Children’s Hospital at Sinai, 5101 Lanier Avenue, Baltimore, MD, 21215, USA

    Katherine A. Connor

  2. Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA

    Diana Cheng

  3. Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Donna Strobino & Cynthia S. Minkovitz

  4. Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Cynthia S. Minkovitz

Authors
  1. Katherine A. Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diana Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donna Strobino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cynthia S. Minkovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine A. Connor.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Connor, K.A., Cheng, D., Strobino, D. et al. Preconception Health Promotion Among Maryland Women. Matern Child Health J 18, 2437–2445 (2014). https://doi.org/10.1007/s10995-014-1482-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-014-1482-3

Keywords

  • Interconception care
  • Preconception care
  • Preventive care
  • Women’s health