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Preconception Care the "New Prenatal Care"
Nathalie Smith, RN, MSN
Monday February 26, 2007

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Organic nutrition information available

Organic foods are no longer just health food store fare. In recent years, organic products have migrated to aisles of mainstream supermarkets and onto dinner tables across America. While organic foods have become more prevalent, consumers — and mothers in particular — may have questions about their nutritional value.

Facts about organic foods, antibiotic and pesticide use in farming, and preconception organic nutrition can be found in Fast Facts for Families: What You Need to Know About Organic Foods and Nutrition, a publication of the National Healthy Mothers, Healthy Babies Coalition.
The publication can be downloaded for no charge at www.hmhb.org/pub_mater.html.

More Clinical News was compiled by Jennifer Thew, RN, MSJ, an editorial director for Nursing Spectrum.

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Remember when nurses and physicians began recommending folic acid supplements for women considering pregnancy? This successful (and simple) health measure changed lives for the better by cutting infants’ risk for spina bifida by more than 70%. Folic acid provides a prime example of how the care and education women receive before they conceive can yield substantial benefits for the health of their newborns.

Despite the many advances in American health care over recent years, the health of the nation’s infants still has a long way to go. One in four babies is premature, underweight, or born with a major birth defect. Two of 3 of women who could become pregnant do not take folic acid supplements, 1 in 10 smokes or drinks alcohol, and 1 in 3 is obese, which increases the likelihood of gestational diabetes and other conditions detrimental to a successful pregnancy such as pre-eclampsia, poor prenatal fetal assessment, and problems with labor and delivery.

“Pre” is key

Birth defects can develop as early as four weeks after conception — long before many women realize they are pregnant — so prenatal care may not come soon enough to prevent serious risks to babies’ health, says Pilar Bernal de pheils, RN, MS, professor of nursing at the University of California, San Francisco. “The goal of preconception care is to improve women’s health before they conceive so they can have healthy babies,” says Bernal de pheils, who is a nurse practitioner and a midwife. “This is important to us as nurses because our professional passion is promoting good health and preventing disease.”

In 2006, the Centers for Disease Control and Prevention (CDC) published guidelines for preconception care in partnership with more than 30 nursing and medical professional organizations. These recommendations are designed to foster the best possible reproductive health for women and couples and promote health education and identify risks, particularly among women who are most vulnerable to poor pregnancy outcomes.

“I think these new guidelines will be well-accepted by nurses in women’s health because they involve just what nurses do — education, wellness care, and preventive care,” Bernal de pheils says. “We’re telling women these steps will help them have a healthy baby, and that can benefit their family for generations. This motivates women to move toward healthy behaviors.“

A crucial step for older mothers

Preconception care is especially important for mothers of advanced maternal age (AMA), Bernal de pheils points out. “The older we get, we have more chronic illnesses and a much higher rate of high-risk pregnancies,” she says. “Also, women in their 30s and 40s might assume they can’t get pregnant and then find themselves with unintended pregnancies.”

Risks associated with AMA pregnancies include Down syndrome, pre-eclampsia, and diabetes. Potential AMA mothers may consider genetic testing. They also need to carefully evaluate the lifestyle-related changes a new child will bring. Can an aging mother (and her partner) pay for their child’s education at retirement age? Will they have the energy to raise a young child? Are they willing to adjust their career paths to properly care for a child?

Demographics and vulnerability

Family history, socioeconomic status, and demographics all influence the quality of a woman’s preconception care. Many low-income families cannot afford routine medical care, much less preconception counseling. Consequently, it is important to address preconception care at all gynecology visits. Says Bernal de pheils, “We especially need to reach our low-income families because they often delay prenatal care and their babies are at greater risk.”

Preconception care is not only about women. “We need to include the dads because their lifestyle choices can affect babies, too,” says Bernal de pheils. “If men smoke, then secondhand smoke is an issue. If they use drugs or alcohol,
we know this increases the risk of domestic violence.”

Bernal de pheils acknowledges that good prenatal care has resulted in better pregnancy outcomes in recent years, but adds, “The approach for today is preconception care. And providing this care is satisfying for us as nurses and excellent for society overall.”

Nathalie Smith, RN, MSN, is a board-certified nurse practitioner and freelance writer based in Lincoln, Neb.




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