Pregnancy is a time of renewed wellness for many women, a time to focus on their health and the health of their unborn child. Many people do not realize that it’s important to optimize health even before conception. A working group of public health officials, clinicians, and researchers came together to make a verifiable “To Do” list of wellness practices that practitioners should help women achieve before they conceive.
In 2003 the Centers for Disease Control and Prevention brought together a working group to compile a list of recommendations for improving women’s health and healthcare before they became pregnant. In the May 2016 Green Journal, this group of women’s health experts puts forth their nine recommendations for preconception wellness. They recommend clinicians measure these nine metrics at the first prenatal care appointment to get a sense of preconception wellness. Why is this important? The public health statistics don’t lie: the United States has the highest health care spending in the world, but our infant mortality rate is in 26th place. The US is the only developed country where mothers are dying or experiencing severe complications at an increasing rate. The authors of the report are sure to clarify: these nine metrics are not a report card for individual doctors or patients. Instead, they reflect the performance of the entire health care system, which must come together to achieve these goals.
How did the working group pick just nine metrics? Over several meetings, they looked for the measures that affect pregnancy outcomes, are common, and are easy to assess.
1. Pregnancy intention: Unintended pregnancies make up about 50% of pregnancies in the United States and are more likely to have adverse birth outcomes.
2. Access to care: Having access to care early in pregnancy is important for screening and interventions to allow for the healthiest pregnancy possible. Women without access to healthcare before and in the first stages of pregnancy miss out on these important benefits.
3. Multivitamin with folic acid prior to conception: Taking a folic acid supplement before conception reduces the risk of neural tube defects (birth defects associated with the spinal cord) by 70%.
4. Tobacco avoidance: Stopping smoking before conception is critical. About 19% of reproductive-aged US women use tobacco, but stopping decreases the risk of preterm birth, disorders of high blood pressure during pregnancy, and low birth weight.
5. Treat uncontrolled depression: Women who suffer from depression, anxiety, and other stress disorders are at increased risk of pregnancy complications and postpartum depression. It’s important to provide resources to women before conception to help them get treatment for anxiety and depression.
6. Healthy weight: Last week I blogged about weight gain in pregnancy, but the best way to achieve a healthy balance is to start at a health weight. Pregnancies that start with a weight that is too high or too low have a higher risk of preterm birth, preeclampsia, miscarriage, and stillbirth.
7. Absence of STDs: Sexually transmitted infections can directly affect a pregnancy, causing complications or birth defects in the growing baby. Screening before and early in pregnancy can allow for treatment and risk reduction.
8. Good blood sugar control for women with diabetes: About 3% of women have diabetes before they become pregnant. If blood sugar is uncontrolled before and during pregnancy, both the mother and infant are at risk of complications such as stillbirth and macrosomia (high birth weight).
9. Avoidance of medications that cause birth defects: 10-15% of birth defects are caused by medications, alcohol, or other outside factors. Most (80%) of women take a medication in the first trimester, so it’s extra important to make sure that those medications are safe in pregnancy. The best way to prevent a birth defect is to eliminate dangerous medications before conception.
The working group considered other metrics in addition to these nine, but in the end, they decided these were the most important to include because they affected the most women and were the most easily measured. Their hope is that bringing awareness to the importance of these goals will lead to better wellness before conception and, ultimately, safer, healthier pregnancies.