Preconception healthcare: Addressing women's knowledge of risk factors for improved pregnancy outcomes

In 2005 the CDC and March of Dimes convened a national summit on preconception. Of concern was the high rate of adverse pregnancy outcomes despite the majority of U.S. women receiving early prenatal care. The panel recommendations form a model for local, state, and federal planning. The purpose of this study is to evaluate the knowledge of preconception risk factors (e.g., folate and vitamin supplementation, alcohol and smoking use, and obesity) of women of childbearing age in three community health centers in lower income and racially mixed areas of Westchester County, NY and to identify opportunities to introduce culturally appropriate risk reduction education. For this population, low birth weight and preterm birth rates exceed those of New York State and Healthy People 2010 goals. Surveys were self-administered by eligible women (n=300) and were available in English and Spanish. Questions came from surveys developed by the March of Dimes and the CDC's Pregnancy Risk Assessment Monitoring System. The instrument had been validated in a previous pilot study and approved by the New York Medical College IRB. Preliminary analyses reveal that three-quarters of the women had their first prenatal visit between the fourth and eighth week; 52% received no multivitamin or folate supplementation prior to their knowledge of pregnancy; and 39% reported having at least one drink/week during the last 3 months of pregnancy. The case for providing preconception care is convincing, and the design of appropriate educational interventions requires a regional and cultural understanding of women's knowledge of risk factors.