Preconception health counseling is gaining acceptance among nurses and doctors in the maternal-child health field as a necessary first step for all women of reproductive age. But it is challenging to get the word out to women and practitioners outside maternal-child health, says one nurse advocate, that counseling can impact pregnancy outcomes, even for women who are not considering pregnancy.
That advocate, Margaret Comerford Freda, RN, EdD, CHES, FAAN, broadly describes preconception health as getting into the best possible health status before a woman conceives. Freda, editor of The American Journal of Maternal Child Nursing and professor of clinical obstetrics, gynecology, and womens health at Albert Einstein College of Medicine at Montefiore Medical Center in Bronx, N.Y., says preconception counseling is becoming more important as the number of women who are considered at high risk increases, thanks to modern medicine.
Now you find women who have had heart transplants as children becoming pregnant, and women who have chronic heart disease, hypertension, and diabetes, Freda says. We have lots of older women becoming pregnant.
The goal of the counseling for high-risk women who might have pre-existing diabetes, asthma, thyroid disease, heart disease, or other chronic conditions, is to help them achieve optimal health and control over the condition before becoming pregnant.
All women, however, can benefit from learning what the program teaches about proper nutrition, exercise, stress management, folic acid intake, and more.
The important thing about preconception health is that it isnt just about women who have high risk conditions; its about all women (of childbearing age), Freda says.
The U.S. Centers for Disease Control and Prevention is promoting preconception health in what it calls the need for women to have a reproductive life plan. The idea behind the plan, according to Freda, is that each woman has a plan about what she wants to do concerning her reproduction, whether she is in perfect health or not. The approach can reduce unplanned pregnancies and help women make lifestyle changes in advance to have healthy pregnancies. One step, Freda says, is to take folic acid daily at least six months before conception, which has been shown to help prevent most neural tube defects, such as spina bifida.
The CDC feels that preconception health is so important that they put together a select panel to study the issue. I was a member of that panel (of nurses, physicians, insurance industry representatives, and others) and … we came up with a plan for preconception health for women in the U.S., she says.
At the Local Level
Albert Einstein College of Medicine at Montefiore Medical Center is among the centers in the U.S. that offers such a program, called the Comprehensive Preconception and Interconception Care program. Ashlesha Dayal, MD, OB/Gyn and director of the Montefiore preconception program, says the program focuses on women with risk factors for adverse outcomes.
Although Dayal admits comprehensive research about the need for preconception healthcare is lacking, there is data on the components of care taught by the program.
In certain conditions, preconception intervention has been very successful in pregnancy outcomes, Dayal says. One classic example is that women who have diabetes before their pregnancies have much better outcomes if they control their diabetes before becoming pregnant.
Janice Hackney, RN, BSN, OB perinatal nurse specialist, works alongside Dayal in the Montefiore program. She says women attend a group session, led by Hackney, and a one-on-one planning session with Dayal.
The first session is the foundation, Hackney says. It gives information about diet, exercise, the importance of folic acid, stress management. We talk about birth control. … It lays the foundation for them to think about making the body healthy.
Although some insurance carriers cover preconception counseling, especially for high-risk women, many do not. Freda recommends practitioners build in preconception visits during patients annual gynecology visits. That way, the service is covered as part of well-woman care.
Nurses have daily opportunities to reach women of reproductive age about planning for pregnancy. Nurses are probably the most important patient educators that there are, Freda says.
Nurses can learn more about preconception counseling through the March of Dimes continuing education programs. In fact, nurses often drive preconception programs and offer the bulk of patient counseling, says Freda, chair of the March of Dimes National Nurse Advisory Council.
Nurses are patient educators, Freda says. Nurses deal with women of reproductive age every single day of the week and whether nurses are pediatric nurses, med/surg nurses, or surgical or orthopedic nurses, they are going to be dealing with women of reproductive age. They have a perfect opportunity to talk to women about their reproductive life plan while they are teaching them other things they need to know.
For information about preconception health, visit www.cdc.gov/ncbddd/preconception/links.htm.