Abstract
Despite evidence of the benefits of preconception health care (PCHC), little is known about awareness and access to PCHC for rural, reproductive-aged women. This study aimed to assess the prevalence of PCHC conversations between rural reproductive-age women and health care providers, PCHC interventions received in the past year, and ascertain predictors of PCHC conversations and interventions. Women (n = 868; 18–45 years) completed a questionnaire including reproductive history, health care services utilization, and interest in PCHC. The prevalence of health care providers’ PCHC conversations was 53.9 %, and the mean number of interventions reported was 2.6 ± 2.7 (±SD). Significant predictors of PCHC conversation based on adjusted odds ratios from logistic regression were race (Native American 76 % greater than White), health care provider type (non-physician 63 % greater than physician), visits to a health care provider (3+ times 32 % greater than 1–2 times), and pregnancy planning (considering in next 1–5 years 51 % greater than no plans). Significant predictors of PCHC interventions received in the past 12 months based on adjusted risk ratios from negative binomial regression were race (Native American 22 % greater than White), PCHC conversation with a health care provider (yes 52 % lower than no), reporting PCHC as beneficial (yes 32 % greater than don’t know), and visits to a health care provider in the past year (3+ times 90 % greater than 1–2 times). Increasing conversations about PCHC between health care providers and their reproductive-aged patients can improve awareness and increase their likelihood of receiving all of the recommended interventions.
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References
World Health Organization. (2013). Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity, February 2012. [meeting report]. Geneva: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/10665/78067/1/9789241505000_eng.pdf.
Centers for Disease Control and Prevention. (2012). Preconception health and health care: Information for health professionals. Retrieved from http://www.cdc.gov/preconception/hcp/index.html.
Berghella, V., Buchanan, E., Pereira, L., & Baxter, J. K. (2010). Preconception care. Obstetrical and Gynecological Survey, 65(2), 119–131. doi:10.1097/OGX.0b013e3181d0c358.
Centers for Disease Control and Prevention. (2006). Recommendations to improve preconception health and health care—United States: A report on the CDC/ATSDR Preconception Care Workgroup and the Select Panel on Preconception Care. Morbidity and Mortality Weekly Report, 55, 1–23. Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr5506.pdf.
Freda, M. C., Moos, M. K., & Curtis, M. (2006). The history of preconception care: Evolving guidelines and standards. Maternal and Child Health Journal, 10, S43–S52. doi:10.1007/s10995-006-0087-x.
Salganicoff, A. & An, J. (2008). Making the most of Medicaid: Promoting the health of women and infants with preconception care. Women’s Health Issues, 18, S41–S46. doi:10.1016/j.whi.2008.07.009.
Misra, D., Guyer, B., & Allston, A. (2003). Integrated perinatal health framework: A multiple determinants model with life span approach. American Journal of Preventive Medicine, 25(1), 65–75. doi:10.1016/S0749-3797(03)00090-4.
Misra, D. P., & Grason, H. (2006). Achieving safe motherhood: Applying a life course perspective and multiple determinants perinatal health framework in public health. Women’s Health Issues, 16, 159–175. doi:10.1016/j.whi.2006.02.006.
Floyd, R. L., Johnson, K. A., Owens, J. R., Verbiest, S., Moore, C. A., & Boyle, C. (2013). A national action plan for promoting preconception health and health care in the United States (2012–2014). Journal of Women’s Health, 22(10), 797–802. doi:10.1089/jwh.2013.4505.
American College of Obstetrics and Gynecology. (2015). Good health before pregnancy: Preconception care. Retrieved from http://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Preconception-Care.
Murphy, S.L., Kochanek, K.D., Xu, J.Q., & Arias, E. (2015). Mortality in the United States, 2014. NCHS data brief, no. 229. Hyattsville, MD: National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db229.pdf.
Burris, H., & Werler, M. (2011). U.S. provider reported folic acid or multivitamin ordering for non-pregnant women of childbearing age: NAMCS and NHAMCS, 2005–2006. Maternal and Child Health Journal, 15(3), 352–359. doi:10.1007/s10995-010-0587-6.
Tough, S., Clarke, M., Hicks, M., & Cook, J. (2006). Pre-conception practices among family physicians and obstetrician-gynecologists: Results form a national survey. Journal of Obstetrics and Gynaecological Cancer, 28(9), 780–788.
Morgan, M., Hawks, D., Zinberg, S., & Schulkin, J. (2006). What obstetrician-gynecologists think of preconception care. Maternal and Child Health Journal, 10(5 Suppl.), S59–65. doi:10.1007/s10995-006-0086-y.
Johnson, K., Atrash, H., & Johnson, A. (2008). Policy and finance for preconception care opportunities for today and the future. Women’s Health Issues, 18(6 Suppl), S2–S9. doi:10.1016/j.whi.2008.09.006.
Posner, S. F., Broussard, D. L., Sappenfield, W. M., Streeter, N., Zapata, L. B., & Peck, M. G. (2008). Where are the data to drive policy changes for preconception health and health care? Women’s Health Issues, 18(6 Suppl), S81–S86. doi:10.1016/j.whi.2008.07.001.
Cheng, D., Schwarz, E., Douglas, E., & Horon, I. (2009). Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception, 79(3), 194–198. doi:10.1016/j.contraception.2008.09.009.
Zhangbin, Y., Shuping, H., Jingai, Z., Xiaofan, S., Chenbo, J., & Xirong, G. (2013). Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: A systematic review and meta-analysis. PLoS One, 8(4), e61627. doi:10.1371/journal.pone.0061627.
Hackshaw, A., Rodeck, C., & Boniface, S. (2011). Maternal smoking in pregnancy and birth defects: A systematic review based on 173,687 malformed cases and 11.7 million controls. Human Reproduction Update, 17(5), 589–604. doi:10.1093/humupd/dmr022.
Patra, J., Bakker, R., Irving, H., Jadobe, V. W., Malini, S., & Rehm, J. (2011). Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birth weight, preterm birth, and small for gestational age: A systematic review and meta-analysis. BJOG: An International Journal of Obstetrics and Gynecology, 118(12), 1411–1421. doi:10.1111/j.1471-0528.2011.03050.x.
Thompson, K. M., Simons, E. A., Badizadegan, K., Reef, S. E., & Cooper, L. Z. (2016). Characterization of the risks of adverse outcomes following rubella infection in pregnancy. Risk Analysis, 36(7), 1315–1331. doi:10.1111/risa.12264.
Tran, T. T. (2016). Hepatitis B in pregnancy. Clinical Infectious Diseases, 62(Suppl. 4), S314–S317. doi:10.1093/cid/ciw092.
De-Regil, L. M., Peña-Rosas, J. P., Fernández-Gaxiola, A. C., & Rayco-Solon, P. (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews, 12. doi:10.1002/14651858.CD007950.pub3.
Johnson, H. L., Ghanem, K. G., Zenilman, J. M., & Erbelding, E. (2011). Sexually transmitted infections and adverse pregnancy outcomes among women attending inner city public sexually transmitted diseases clinics. Sexually Transmitted Diseases, 38(3), 167–171.
Wahabi, H. A., Alzeidan, R. A., Bawazeer, G. A., Alansari, L. A., & Esmaeil, S. A. (2010). Preconception care for diabetic women for improving maternal and infant health: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 10, 63. doi:10.1186/1471-2393-10-63.
Bramham, K., Parnell, B., Nelson-Piercy, C., Seed, P. T, Poston, L., & Chappell, L. C. (2014). Chronic hypertension and pregnancy outcomes: Systematic review and meta-analysis. BMJ, 348, g2301. doi:10.1136/bmj.g2301.
Xu, F., Town, M., Balluz, S., et al. (2013). Surveillance for certain health behaviors among states and selected local areas—United States, 2010. MMWR: Morbidity and Mortality Weekly Report, 62(ss01), 1–247.
Robbins, C. L., Zapata, L. B., Farr, S. L., et al. (2014). Core state preconception health indicators—pregnancy risk assessment monitoring system and behavioral risk factor surveillance system, 2009. MMWR: Morbidity and Mortality Weekly Reports, 63(3), 1–62. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6303a1.htm.
United States Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (2013). Child Health USA 2012. Rockville, MD: United States Department of Health and Human Services. Retrieved from http://mchb.hrsa.gov/chusa12/more/downloads/pdf/chusa12.pdf.
Frey, K. A., & Files, J. A. (2006). Preconception health care: What women know and believe. Maternal and Child Health Journal, 10, S73–S77. doi:10.1007/s10995-006-0110-2.
Harelick, L., Viola, D., & Tahara, D. (2011). Preconception health of low socioeconomic status women: Assessing knowledge and behaviors. Women’s Health Issues, 21(4), 272–276. doi:10.1016/j.whi.2011.03.006.
Economic Research Service. (2013). 2013 Urban influence codes. United States Department of Agriculture. Retrieved from http://www.ers.usda.gov/data-products/urban-influence-codes.aspx.
Hedman, A. S. (2008). Using the SMOG formula to revise a health-related document. American Journal of Health Education, 39(1), 61–64. doi:10.1080/19325037.2008.10599016.
Hutchinson, M., & Holtman, M. (2005). Analysis of count data using poisson regression. Research in Nursing & Health, 28(5), 408–418. doi:10.1002/nur.20093.
United States Department of Health and Human Services, Health Resources and Services Administration. (2013). Women’s Health USA 2013. Rockville, MD: United States Department of Health and Human Services, Health Resources and Services Administration. Retrieved from http://mchb.hrsa.gov/whusa13/dl/pdf/whusa13.pdf.
The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. (2014). Committee opinion no. 586: Health disparities in rural women. Obstetrics & Gynecology, 123(2, Part 1), 384–388. doi:10.1097/01.AOG.0000443278.06393.d6.
United States Census Bureau. (2010). South Dakota quick facts statistics, 2015. Retrieved from http://www.census.gov/quickfacts/table/PST045215/46.
Weisman, C. S., Hillemeier, M. M., Chase, G. A., et al. (2008). Women’s perceived control of their birth outcomes in the Central Pennsylvania Women’s Health Study: Implications for the use of preconception care. Women’s Health Issues, 18(1), 17–25. doi:10.1016/j.whi.2007.08.001.
Files, J. A., Frey, K. A., David, P. S., Hunt, K. S., Noble, B. N., & Mayer, A. P. (2011). Developing a reproductive life plan. Journal of Midwifery & Women’s Health, 56(5), 468–474. doi:10.1111/j.1542-2011.2011.00048.x.
Acknowledgments
The authors wish to thank Taylor Mertz, APRN, CNM, for her work on data entry and preparation for analysis.
Funding
The study was supported by a grant from SDSU Office of Research, Grants and Sponsored Programs—Li-U-Funded Research-10-11.
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The authors declare that they have no conflicts of interest.
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Informed consent was obtained from each study participant using methods prescribed by the South Dakota Institutional Review Board.
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The South Dakota State University Institutional Review Board approved the study before collecting data.
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Lammers, C.R., Hulme, P.A., Wey, H. et al. Understanding Women’s Awareness and Access to Preconception Health Care in a Rural Population: A Cross Sectional Study. J Community Health 42, 489–499 (2017). https://doi.org/10.1007/s10900-016-0281-8
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DOI: https://doi.org/10.1007/s10900-016-0281-8