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Vital Signs

Making pre-pregnancy a perpetual mindset

By Laura Evancich

If the Centers for Disease Control and Prevention (CDC) gets its way, American women will start receiving prenatal care long before they ever get pregnant. In April, the CDC's Morbidity and Mortality Weekly Report contained national recommendations meant to improve the health of all women of childbearing age, so if and when they decide to have children they're more likely to give birth to healthy babies.

About 85% of U.S. women receive prenatal care—after they get pregnant. Yet the U.S. ranks 26th among developed nations in infant mortality and has higher rates of low-birth-weight babies and premature births than comparable countries.

Panel: "What this is is a campaign for health in general," says Dartmouth neonatologist Dr. George Little, a member of the CDC's Select Panel on Preconception Care, which contributed to the report. "It's what I call 'reproductive awareness': it's being aware of the fact that you have to be healthy and prepared for a pregnancy." Many couples, he adds, think about optimizing a successful pregnancy only after conception has taken place. But that may be too late to ensure that an infant is born healthy.

Under the new guidelines, childbearing-age women are advised to take folic acid supplements; refrain from smoking and excessive drinking; maintain a healthy weight; and gain control of chronic conditions such as epilepsy, asthma, depression, or diabetes. Women with chronic health conditions may have to do even more to be baby-ready and should see a specialist before getting pregnant. And those taking medication—either prescription or over-the-counter drugs—should let their doctors know, as some drugs may be detrimental to fetal development.

Plan: The report also recommends that everyone of childbearing age, men and women, develop a reproductive life plan describing if and when they intend to have children. And it advises pre-pregnancy checkups to discuss long-term reproductive health. "Having a baby is a choice," says Little, and doctors should take that choice into account whenever they bring up reproductive-health planning.

Dartmouth-Hitchcock is one of 35 organizations—including the CDC, the American College of Obstetrics and Gynecologists, and the March of Dimes—collaborating to educate women and doctors about preconception care. DHMC has begun to offer its providers training in preconception care, including an online interactive course on smoking cessation. And after giving birth at DHMC, even before leaving the hospital, couples now receive counseling on interconception care, or planning between pregnancies. But "the major place for where the intervention needs to occur is not in the hospital, but in the doctor's office and in the community and in education," says Little.

Goal: He acknowledges that promoting preconception care to minors may generate controversy. But people should not confuse it with instruction on sexual behavior, he says. The goal of the CDC recommendations "is to raise the level of health in our society as a whole."

There "are quite a number of things recommended as screening in primary care which are not routinely done for women today" and which may mean the difference between a healthy infant and a sick one, says DMS pediatric researcher Kay Johnson, who is also a member of the Select Panel.

Johnson and Little will continue to work with the CDC to integrate the guidelines into medical practices and public health programs.

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