Preconception Health Planning: Improving Outcomes

Saturday, 29 July 2017: 9:30 AM

Julie A. Fitzgerald, PhD, RN, CNE
Department of Nursing, Ramapo College of New Jersey, Mahwah, NJ, USA


Current data suggests that lack of engagement in preconception health planning is a global problem and new approaches are needed to prevent preterm births and improve pregnancy outcomes. Many pregnant women make lifestyle changes during pregnancy to promote their health and the health of the fetus. Studies note that pre-conceptual health of both the mother and father influence pregnancy outcomes (Ding, Li, Xie & Yang, 2015; Moss & Harris, 2015). The CDC and Workgroup of the National Preconception Health and Health Care Initiative (Frayne, Verbiest., Chelmow,, Clarke, Dunlop, Hosmer, & ... Stuebe 2015) identified the need for preconception health screening, assessment and education to improve birth outcomes. They estimate as many as one in ten women had a poor birth outcome and needed interventions to improve health, with minority and poor women at higher risk (CDC, 2006, 2015). The CDC recommends that risk assessment and health education be part of all primary care visits (CDC, 2015; Hurst & Linton, 2015). In spite of these recommendations PRAMS data from 2004-2010 from twelve states in the United States reported that only one third of women who delivered reported receiving preconception health planning (Ozra-Frank, Gilson, Keim, Lynch & Kiebanoff, 2014). The government of China, offered free preconception health planning to Chinese men and women to improve birth outcomes. A survey of over 12,000 pregnant women and men living in China, revealed that although the majority knew of the service, only 40% accessed the service (Ding, Li, Xie & Yang, 2015). Likewise, a survey of pregnant women living in London, noted that although 73 % of women planned their pregnancy less than 50% received pre conceptual care (Stephenson, Patel,Barrett, Howden, Copas, Ojwuku et. al. , 2014). Further assessment of this population revealed although many reduced alcohol and quit smoking prior to conception, only 51% reported taking folic acid. Few studies have focused on the postpartum as a time to incorporate pre-conception health planning.


Based on the need to improve birth outcomes and reduce the number of preterm births, the March of Dimes funded a Nurse Educator/Health Coach to work with mothers of infants admitted to the NICU. The Nurse Educator/Health Coach recruited (N=70) mothers of preterm infants admitted to the NICU, to learn about stress reduction and healthy lifestyles. Since mothers who give birth to preterm infants, often have health risks and may have a subsequent preterm birth the education focused on preconception care. The Nurse Educator assigned to the project, administered a pregnancy quiz (to assess knowledge of healthy pregnancy) a Risk Assessment Survey, and provided patient education with a Preconception Health Education Module developed by the March of Dimes. All participants received individualized risk assessment and education regarding importance of folic acid intake prior to conception, pregnancy spacing, postpartum depression, healthy eating, importance of management of chronic diseases, stress reduction techniques and the value of exercise. Additional education was targeted related to specific clinical conditions or knowledge deficits, including hypertension,obesity, diabetes, substance abuse, weight loss and diabetes, based on an evaluation of the individual mother’s risk assessment and pregnancy quiz. Mothers were encouraged to identify one health goal and define strategies to achieve that goal. The nurse educator used motivational interviewing to discuss the benefits of the goal selected. As part of the evaluation for the educational project, mothers who participated were contacted two to six months after the intervention to assess if they had made changes in their health behaviors.


Seventy mothers from diverse backgrounds, received education in the NICU during the project year. Twenty-five successful follow up phone calls were conducted. Nineteen women (76%) of those in the follow up group reported positive lifestyle changes. These changes included: fourteen women reported eating healthier, with six reporting weight loss, three reported increasing exercise, and two reported a decrease in smoking behavior. One reported quitting completely and one reported decreasing the number of cigarettes smoked daily. Six participants reported no change in health behavior. Overall, it appears that women are receptive to health education during the postpartum period. Some participants reported although they wanted to make lifestyle changes such as exercising, they were overwhelmed caring for their infant and planned to try in the future. Many follow ups could not be completed due to the fact participants changed phone numbers or used cell phones that did not accept calls.


The early postpartum period may be an ideal time for nurses to provide targeted education and reinforce the need to continue positive lifestyles changes to improve the health of the mother and ensure a healthy pregnancy in the future. Nurses that provide care for women of reproductive age should provide pre-conception care and health education at every visit. Behavior changes such as smoking cessation, healthy eating and exercise can positively impact future pregnancies and the health of the whole family. Adopting healthy eating patterns and getting regular exercise can improve mood, reduce stress, reduce the incidence of Type 2 Diabetes and improve cardiovascular health. Further longitudinal research to determine if changes in health behaviors made in the pregnancy and postpartum period are sustained and identification of strategies that empower women to improve their health are indicated.