Preconception Health Promotion Research Articles

Naturopaths’ approach to care of women with infertility: A cross-sectional survey

IntroductionInfertility affects approximately one in six couples of reproductive age. Many women use traditional, complementary and integrative medicine to improve their chances of conceiving. While there is evidence of the use of naturopathy by women attempting to conceive, there is no evidence of the way that naturopaths approach and manage their treatment. This study aims to describe how naturopaths manage female infertility, including their approaches, clinical decisions, knowledge sources, and safety considerations in providing naturopathic care. MethodsNaturopaths in Australia or New Zealand, routinely treating female reproductive health concerns and practicing for at least two years were invited to complete an online survey through their professional naturopathic associations. ResultsData from 45 respondents were included. Women seeking preconception health and fertility promotion were frequently seen by 53 % and 44 % of the naturopaths, respectively. The naturopaths’ clinical management approaches for infertility were wide-ranging and extended beyond fertility. They reported prioritising peer-reviewed journal articles in guiding clinical decisions, collaborating with health practitioners (mostly general practitioners) and reporting adverse events. Most naturopaths (95 %) utilised multiple treatment strategies, recommending dietary and lifestyle modifications and a combination of ingestible substances. ConclusionsThe naturopathic approach to management of women with infertility is holistic, considering physical, emotional, and environmental factors and promoting natural healing mechanisms. Greater knowledge of scientific methods for clinical decision-making and improved awareness of adverse event reporting would enhance naturopathic care. Additionally, evaluating the effectiveness of naturopathic treatment would improve safety, inform the profession, and clarify the role of naturopathy within a multidisciplinary approach to infertility.

Feasibility, acceptability & preliminary efficacy of a digital preconception intervention: OptimalMe

Abstract Background Women's health prior to pregnancy is an increasing area of public health focus. Lifestyle interventions in preconception may be an ideal to target lifestyle behaviours that impact preconception and pregnancy health. However, there are limited interventions initiated prior to pregnancy. This study assesses the feasibility, acceptability and preliminary effectiveness of a digital healthy lifestyle behaviours intervention in women planning a pregnancy. Methods Participants were provided digital health and lifestyle information, health checklist, goal setting tools and virtual health coaching (telephone or video conference). Feasibility was defined as 1) recruitment of eligible participants who expressed interest, 2) retention from baseline through delivery (attending both preconception coaching sessions), and 3) adherence, based on attending one health coaching session, using the digital goal setting tool and accessing at least one information article. Acceptability was based on program components evaluated as helpful/very helpful. Preliminary intervention efficacy was based on participants attending a preconception consultation with a genera l practitioner (GP). Results Women (n = 298) planning a pregnancy within 12 months were recruited. Feasibility objectives were met, with 60% (n = 298/494) recruitment, 76% (n = 227/298) retention and 85% (n = 252/298) adherence. Evaluation demonstrated high levels of acceptability: digital module (95% n = 205/216), physical activity/diet information (90% n = 195/216), preconception health information (91% n = 195/215), coaching (92% n = 198/216), lifestyle SMSs (72% n = 153/213) and self-weighing (74% n = 159/215). Since the intervention, 73% (n = 159/217) had visited their GP in preparation for pregnancy. Conclusions The OptimalMe preconception intervention demonstrated feasibility, high acceptability and efficacy in women planning a pregnancy. This supports future digital health interventions in preconception; pregnancy results pending. Key messages • Interventions prior to pregnancy are limited, yet women’s health prior to pregnancy is an increasing area of public health focus. • Digital health interventions are feasible and acceptable for preconception health and lifestyle health promotion for women planning a pregnancy.

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study

PurposePregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors.MethodsA cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18–39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations.ResultsSurvivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior.ConclusionsIncreasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA.Implications for cancer survivorsScreening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

The Evaluation of Online Learning Modules to Increase the Capacity of Nurses and Midwives in Promoting Preconception Health in Primary Health Care Services at Tiara Kasih Sejati Hospital Pematangsiantar

This study aims to find out how to develop an online learning module to increase the capacity of nurses and midwives in promoting preconception health in primary health care services at Tiara Kasih Sejati Hospital Pematangsiantar. This type of research is classified into descriptive research with a quantitative approach. The sample of this study amounted to 93 samples consisting of midwives and nurses. Data was collected by using counseling methods and giving questionnaires. Data analysis using univariate. The results showed the difference in the increase in respondents' knowledge of 4.34 so that the average score of respondents' knowledge before and before being given the online learning module increased from 9.52 to 13.86. The benefit of the module is to increase the perception of midwives and nurses in improving health preconceptions in primary health care settings by 75.3% of midwives and pediatric nurses increasing the promotion of health preconceptions in primary health care settings. The ability level of midwives and nurses in accessing online learning modules regarding preconception is 55.9% the best and 44.1% not good. The assessment of the quality of the online learning module given to midwives and nurses, midwives and nurses who rated it good was 77.4% and those who rated it bad were 22.6%. The nutritional needs needed during the preconception period are macronutrients and micronutrients.

Empowerment for behaviour change through social connections: a qualitative exploration of women’s preferences in preconception health promotion in the state of Victoria, Australia

BackgroundHealth behaviours in the preconception period have the potential to impact on fertility and pregnancy outcomes, and the health of all women regardless of pregnancy intention. Public awareness of this is low and interventions that promote behaviour change have not been integrated into real-world settings. Aims were to explore women’s understandings of health and health behaviours and what supports are important to promote behaviour change in the preconception period.MethodsThis qualitative study is the first phase of a broader co-design project set in the state of Victoria, Australia. Over 3 months, a series of in-depth interviews were conducted with female participants who were intending to become pregnant in the next 2 years (n = 6) and participants who were not intending to become pregnant in the next 2 years (n = 6). Community advisors (n = 8) aged 18-45 years provided feedback throughout the process. Coding of transcripts from interviews and meetings was undertaken by two researchers before a deductive process identified themes mapped to the COM-B framework.ResultsNine themes and eight sub-themes were identified. Participants had a holistic view of health with nutrition, physical activity and sleep being most valued. Social connections were considered as being important for overall health and wellbeing and for promoting health behaviours. The only difference between groups was that pregnancy was an additional motivator for women who were planning to become pregnant in the next 2 years. A range of health information is available from health professionals and other sources. Unlimited access to information was empowering but sometimes overwhelming. Being listened to and shared experiences were aspects of social connections that validated participants and guided them in their decision-making.ConclusionsWomen valued their health and had a holistic view that includes physical, mental and social dimensions. Women viewed social connections with others as an opportunity to be listened to and to gain support that empowers behaviour change. Future interventions to promote behaviour change in preconception women should consider the importance all women placed on social connections and leverage off existing resources to connect women.

Preconception Health in the Workplace: An Opportunity to Support Equitable Access to Education.

Preconception health is a key determinant of pregnancy and offspring outcomes, but challenges reaching people during preconception are frequently cited by health professionals. This article highlights the workplace as an important setting for promoting equitable access to preconception health-related information and education to support optimal well-being before pregnancy. Workplaces can support equitable access to education and knowledge for preconception health: (1) due to the high engagement of reproductive-age women in the workforce and (2) by reaching vulnerable or high-risk population groups who may otherwise face barriers to accessing preconception health information. Literature that explicitly investigates workplace delivery of preconception health promotion programs is scarce. However, workplace health promotion more broadly is associated with improved corporate competitiveness, productivity, and strengthened employee-employer relationships. Workplace health promotion activities may also address social determinants of health and improve employee well-being outcomes. The opportunity for workplaces to benefit from an increase in the bottom line makes workplace health promotion programs more attractive, but organizational support and stakeholder engagement are needed to facilitate the design and delivery of successful workplace preconception health education programs. Such programs have the potential to facilitate health gains for women and their families.

EVALUATION OF A DIDACTIC TOOLKIT FOR PROMOTING PRECONCEPTION HEALTH AMONG NURSING AND MIDWIFERY STUDENTS

ABSTRACT Ever higher rates of infertility among the population add to the importance of promoting fertility awareness. A digital didactic toolkit was therefore developed for use as educational material. The cross-sectional observational study aimed to test and evaluate a didactic toolkit on reproductive health in the context of nursing and midwifery students. A convenience sample consisted of 88 nursing and 61 midwifery students, all studying full-time. An evaluation questionnaire was developed based on a literature review. The evaluation included 36 didactic tools within the toolkit, divided into 6 categories: Age and Fertility (n = 3), Understanding Reproduction (n = 2), Lifestyle Factors Affecting Fertility (n = 13), Infection Risks (n = 4), Environmental Hazards (n = 1), and Social Environment Issues (n = 13). MATLAB R2017b and SPSS v.26 were used to organize and analyze the data. A web platform providing information on preconception health received positive feedback and was reported to be ‘very good’ for 5 statements and ‘excellent’ for 3 items. The participants identified several groups that could be interested in the didactic toolkit, such as their peers, students, and couples planning a family. The participants already possessed a considerable amount of information about preconception health when they assessed the didactic tools, hence they focused more on its form and design than its content. Social media should be considered as a platform for the ongoing development of the toolkit. To ensure the content is comprehensible, future studies should include participants who are not healthcare professionals.

Assessing Preconception Wellness in the Clinical Setting Using Electronic Health Data.

Background: One key strategy to reduce maternal morbidity and mortality involves optimizing prepregnancy health. Although nine core indicators of preconception wellness (PCW) have been proposed by clinical experts, few studies have attempted to assess the preconception health status of a population using these indicators. Methods: We conducted a retrospective chart review study of patients who received prenatal or primary care, identified by pregnancy-related ICD-10 codes, at either of two health systems in geographically and socioeconomically different areas of North Carolina between October 1, 2015, and September 30, 2018. Our primary study aim was to determine the feasibility of measuring the proposed PCW indicators through retrospective review of prenatal electronic health records at these two institutions. Results: Data were collected from 15,384 patients at Site 1 and 6,983 patients at Site 2. The indicators most likely to be documented and to meet the preconception health goal at each site were avoidance of teratogenic medications (98.8% and 98.3% at Sites 1 and 2, respectively) and entry to care in the first trimester (64.5% and 73.5% at Sites 1 and 2, respectively), whereas our measures of folic acid use, depression screening, and discussion of family planning were documented less than 20% of the time at both sites. Conclusions: Differences in measuring and documenting PCW indicators across the two health systems in our study presented barriers to monitoring and optimizing PCW. Efforts to address health and wellness before pregnancy will likely require health systems and payors to standardize, incorporate, and promote preconception health indicators that can be consistently measured and analyzed across health systems.

Evaluation of an online learning module to improve nurses' and midwives' capacity to promote preconception health in primary healthcare settings.

Optimal parental preconception health improves the likelihood of a successful pregnancy and a healthy child. Although primary healthcare professionals believe that it is within their role to promote preconception health to people of reproductive age, few do this routinely, in part because they lack knowledge on the topic and confidence to discuss it with their patients. The aim of this study was to evaluate the efficacy and acceptability of a free online learning module to assist nurses and midwives in primary health care to promote preconception health in their practice. A repeat online survey was administered before and after completion of the online learning module. The survey included questions gauging knowledge about and attitudes towards promoting preconception health. In all, 121 nurses/midwives completed the two surveys and the learning module. There were statistically significant improvements in the knowledge scores (from 6.42 to 8.31; P < 0.001) and in the proportion of participants who reported feeling confident in their knowledge about preconception health (from 15% to 53%). Almost all (95%) were satisfied with the duration and content of the learning module. The findings of this study suggest that the learning module is acceptable and improves nurses' and midwives' capacity to promote preconception health in their practice.

Preconception women’s views of promoting preconception women’s health in Australia

Sub-optimal lifestyle choices made long before pregnancy have the potential to impact negatively maternal health and pregnancy outcomes. However, many women are unaware of this and do not seek preconception health advice. Using a descriptive qualitative approach, nonpregnant women (n=31) aged 18-45years were purposively recruited to participate in a focus group (n=7) that explored how preconception health is prioritised and how to increase women's awareness and uptake of healthy lifestyle behaviours in the preconception period. Focus group transcripts were coded by two researchers and an inductive process was used to categorise codes into themes. Two themes and five sub-themes relating to the aims of this study were identified. Participants believed preconception health to be important for all women, while admitting that was not a high priority if not planning a pregnancy. Participants suggested a range of interventions that spanned the social-ecological model of health to engage preconception women in preventive actions and promote preconception health. These interventions included having access to reputable and easily accessible online sources of preconception health information, education and at secondary schools and public health campaigns. Future initiatives to engage preconception women should span the social-ecological model of health and consider women's personal preferences for accessible and tailored preconception health information and support at individual, interpersonal, community and organisational levels, as well as in the broader environment. SO WHAT?: This research provides guidance to those in health promotion when planning future initiatives to promote and protect women's preconception health.

Using co-design to develop a culturally responsive reproductive health learning resource for Aboriginal and Torres Strait Islander youth.

Healthy behaviours prior to conception can improve pregnancy outcomes and intergenerational health. Adolescence is an important period to promote preconception health, but education resources need to be age and culturally appropriate. Few studies have addressed preconception awareness and knowledge among Aboriginal and Torres Strait Islander youth, and few culturally appropriate resources exist. A mixed methods, co-design process engaging Aboriginal and Torres Strait Islander youth and an Indigenous Reference Group (IRG). Additionally, a survey was carried out to identify preconception health awareness and interest among a broader youth audience. Several main themes emerged from consultation meetings with youth reflecting an awareness of preconception health, but limited understanding. Youth revealed an interest in fertility, and a need for more information on lifestyle factors associated with infertility. Preconception information related to the opposite sex was seen as important as well as information incorporating current local knowledge and world views. Among the survey respondents, 46% (11/24) had a pre-existing understanding of preconception health. Optimising lifestyle behaviours prior to pregnancy was perceived as important for women (21/24; 88%), but less so for men (16/24; 67%), highlighting a gap in knowledge regarding the importance of preconception health for men. The co-designed resource "Getting healthy before pregnancy" is available in print and electronically, with illustrations and synchronised audio overlay in Aboriginal English or East-side Kriol. The resource includes information on preconception health and behavioural risk factors. We present a co-designed preconception health resource for evaluation with Aboriginal and Torres Strait Islander youth.

Acceptability of screening for pregnancy intention in general practice: a population survey of people of reproductive age

BackgroundOptimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia.MethodThe research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019.ResultsIn all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions.ConclusionFindings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.

Preconception Lifestyle and Weight-Related Behaviors by Maternal Body Mass Index: A Cross-Sectional Study of Pregnant Women.

Obesity is a rising global health challenge, particularly for reproductive-aged women. Our cross-sectional study of pregnant women (n = 223) examined associations between preconception body mass index (BMI) and socio-demographics, weight perceptions and lifestyle behaviors. Over half of women were overweight (33.2%) or obese (22.0%), 49.6% of which perceived their weight as normal. High proportions of women reported planning their pregnancies (70.0%) and were actively trying to lose or maintain their weight preconception (72.7%). Weight management approaches varied from reducing discretionary foods (63.7%) to professional support (8.1%). Obese women had significantly greater odds of reducing discretionary foods (odds ratio (OR) = 6.69 95% confidence interval (CI) 2.13–21.00, p = 0.001) and using structured diets (adjusted odds ratio (AOR) = 9.13 95% CI 2.90–28.81, p < 0.001) compared to normal-weight women. After adjusting for socio-demographics, compared to normal-weight women, overweight (AOR = 5.24 95% CI 2.19–12.56, p < 0.001) and obese (AOR = 2.85 95% CI 1.06–7.67, p = 0.04) women had significantly increased odds of exercising for weight management and significantly lower odds of taking folic-acid preconception (overweight: AOR = 0.40 95% CI 0.18–0.90, p = 0.01, obese: AOR = 0.38 95% CI 0.16–0.91, p = 0.03). Large proportions of women planning a pregnancy have an overweight/obese BMI, with associated suboptimal health behaviors and reduced health professional engagement preconception. Further research exploring women’s perspectives regarding preconception lifestyles is needed to inform effective preconception health promotion strategies.

Measurement of Preconception Health Knowledge: A Systematic Review.

Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges. MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018. Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men. Two independent reviewers completed data extraction and quality appraisal using standardized instruments. Due to measurement heterogeneity, a narrative synthesis was performed. The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men's health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools. This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.

Survey of Maternal, Child and Family Health Nurses' attitudes and practice relating to preconception health promotion.

Environmental factors including poor nutrition, obesity, smoking, exposure to toxins and drug and alcohol use at the time of conception can adversely affect the future health of the offspring. As primary health care (PHC) professionals who interact with women of reproductive age, Maternal, Child and Family Health Nurses (MCaFHNs) are ideally placed to promote preconception health to women who want another child. The aim of this study was to assess MCaFHNs attitudes towards preconception health promotion, whether and under what circumstances they talk to their families about this, and what might help them start a conversation about preconception health. Of the 192 respondents, most (65%) agreed it is part of the MCaFHNs role to promote preconception health but only one in eight (13%) felt very confident that they knew as much as they needed and less than half (46%) 'routinely' or 'sometimes' promoted preconception health in their clinical practice. Almost all agreed that more information and education on the topic would increase their confidence to discuss preconception health. The findings suggest that, with adequate educational and structural support, most MCaFHNs are willing to deliver preconception health promotion in their clinical practice. As most new mothers access MCaFHNs, the potential health benefits of this are considerable.

Periconceptional folic acid supplementation: Knowledge, attitudes and counselling practice of Serbian pharmacists and pharmacy technicians

Background/Aim. The protective effect of periconceptional folic acid supplementation in reducing the risk of neural tube defects (NTDs) and other adverse pregnancy outcomes has been scientifically confirmed. The present study aimed to assess knowledge, attitudes, and practice (KAP) of community pharmacists and pharmacy technicians with regards to counselling women of reproductive age on adequate folate intake. Methods. The cross-sectional study was conducted among the nationwide stratified sample of pharmacists and pharmacy technicians, practicing in both private and state-owned community pharmacies in Serbia. The detailed literature review, expert consultation and pre-testing were employed in the questionnaire development. The descriptive and inferential statistical analyses were performed using the SPSS software ver. 22. Results. Among 730 survey participants, 96.6% correctly identified types of deformities that could be prevented by folic acid and 77.0% recognized recommended dosage for women capable of becoming pregnant. However, fewer were able to recognize the optimal timing for folic acid supplementation (61.1%) and the proper dose for the NTD recurrence prevention (42.9 %). While 43.2% of pharmacy technicians thought that it was not their responsibility to provide a counselling concerning the measures for the prevention of congenital anomalies, only 4.7% of licensed pharmacists and none of the interns were of that opinion (?2 = 198.287; df = 4; p &lt; 0.001). The majority of respondents (54.7%) reported provision of informative consultation concerning folic acid once a week, or few times a month, while only 10 stated to do so on a daily basis. In addition, based on self-report, only 36.7% of participants communicates information and advice regarding adequate folate status at their own initiative, while the rest addresses this topic only on the patients request, i.e., reactively. Conclusion. Although participants acknowledged the importance of their role in preconception health promotion, our findings revealed certain knowledge gaps as well as dominantly reactive counselling practice. Tailored educational interventions and professional support are needed to improve the engagement of community pharmacy personnel in this area of public health.

Development of Preconception Health Behavior Scale.

This study was designed to develop a valid and reliable scale for the evaluation of preconception health behavior in women preparing for pregnancy. The initial strategy included a literature review, interviews, and construction of a conceptual framework. The preliminary items were evaluated twice for content validity by experts, and modified two preliminary investigations. Participants in the 2 main investigations and the confirmation investigation were tested for reliability and validity of the preliminary scale in women preparing for pregnancy. The data were analyzed for different items exploratory and confirmatory factors. The 5-point Likert scale consisted of 6 factors and 27 items. The 6-factors included 'hazardous substance factor,' 'medical management factor,' 'rest and sleep factor,' 'stress management factor,' 'information acquisition factor,' and 'resource preparation factor.' Goodness of fit of the final research model was very appropriate and based on the following measures: Q=1.98, comparative fit index=.91, Tucker-lewis index=.89, standardized root mean square residual=.07, and root mean square error of approximation=.07. The criterion validity was .64. The reliability coefficient was .92 and the test-retest reliability was .61. The study findings indicate that the scale can be used for the development of nursing interventions to promote preconception health behavior in women preparing for pregnancy.

Gender Stereotypes and Preconception Health: Men's and Women's Expectations of Responsibility and Intentions to Engage in Preventive Behaviors.

Introduction As mounting evidence underscores the importance of both men and women taking steps before pregnancy to improve reproductive outcomes, public health priorities are shifting toward a more gender-inclusive program of promoting preconception health (PCH). This study examined whether prescriptive gender stereotypes, defined as men's and women's beliefs about PCH behavioral norms each gender should uphold, were positively associated with intentions to engage in behaviors to protect a future child's health. Methods Data came from a June 2017 online survey of 609 U.S. men and women ages 18-44. Two six-item scales of prescriptive same- and opposite-gender stereotypes were used to predict a six-item scale of intentions to engage in six recommended PCH behaviors (i.e., avoiding smoking, secondhand smoke, drinking, exposure to bisphenol A and pesticides, and preventing Zika infection). Multiple linear regression models also adjusted for demographic, socioeconomic, and health characteristics. Results Among both male and female respondents, PCH prescriptive gender stereotypes for men were rated significantly lower than those for women. Adjusting for covariates, stronger prescriptive same-gender stereotypes were associated with increased PCH intentions (men: B = 0.496, p < 0.001; women: B = 0.486, p < 0.001). Opposite-gender stereotypes were also positively associated with PCH intentions (men: B = 0.205, p < 0.001; women: B = 0.235, p < 0.001). Current every day smoking status (men and women), being uninsured (women only), and having children (women only) were also associated with lower PCH intentions. Conclusion Prescriptive gender stereotypes may play an important, yet slightly different, role in promoting PCH behavior among men and women.

Making the Case: The Importance of Using 10 Key Preconception Indicators in Understanding the Health of Women of Reproductive Age.

In 2006, the Preconception Care (PCC) Work Group and the Select Panel on PCC published 10 recommendations promoting preconception health (PCH) and healthcare for women of reproductive age. In the years following the recommendations, much research focused on specific PCH behaviors, clinical provision of care, and care financing, but no comprehensive, well-defined set of indicators was identified. In 2011, seven states developed a set of 45 PCH indicators; however, to date, no one publication has assessed the usefulness of all 45 indicators in addressing PCH. This report makes the case for reducing the original 45 indicators to a condensed set of 10 for national and state reporting by describing the use of the 45 indicators to date, describing development of evaluation criteria for narrowing the number of indicators, and identifying gaps in indicator development for provision of PCC. Using the condensed set, states can set priorities, revise and develop programs and policies, implement system changes, and better allocate resources to support interventions to improve the health of women of reproductive age during the preconception and interconception periods.

Paid Family Leave to Enhance the Health Outcomes of Preterm Infants.

Prematurity is the largest contributor to perinatal morbidity and mortality. Preterm infants and their families are a significant vulnerable population burdened with limited resources, numerous health risks, and poor health outcomes. The social determinants of health greatly shape the economic and psychosocial resources that families possess to promote optimal outcomes for their preterm infants. The purposes of this article are to analyze the resource availability, relative risks, and health outcomes of preterm infants and their families and to discuss why universal paid family leave could be one potential public policy that would promote optimal outcomes for this infant population. First, we discuss the history of family leave in the United States and draw comparisons with other countries around the world. We use the vulnerable populations conceptual model as a framework to discuss why universal paid family leave is needed and to review how disparities in resource availability are driving the health status of preterm infants. We conclude with implications for research, nursing practice, and public policy. Although health care providers, policy makers, and other key stakeholders have paid considerable attention to and allocated resources for preventing and treating prematurity, this attention is geared toward individual-based health strategies for promoting preconception health, preventing a preterm birth, and improving individual infant outcomes. Our view is that public policies addressing the social determinants of health (e.g., universal paid family leave) would have a much greater impact on the health outcomes of preterm infants and their families than current strategies.