Received Preconception Care Research Articles

The effect of pregnant women's status of receiving preconception care on pregnancy stress.

In the study, we aimed to determine the effect of pregnant women's status of receiving preconception care on their pregnancy stress. This is a descriptive, correlational, and cross-sectional design study, we were conducted with the participation of 409 pregnant women between June-December 2019. The Pregnancy Stress Rating Scale total score mean was found to be 30.72 ± 20.26. Individuals who received medication and vitamins as part of preconceptional care had significantly higher scores (p < 0.05; p < 0.001) compared to those who did not receive them for total pregnancy stress, postpartum social support, infant health, and infant identity-care stress. Similarly, individuals who received medical treatment and regular checkups had significantly higher scores (p < 0.05) compared to those who did not for total pregnancy stress, postpartum social support, infant identity-care, body image and psychological state during pregnancy stress scores. In addition, individuals who maintained a healthy lifestyle had significantly higher scores (p < 0.05; p < 0.001) compared to others for infant health, infant identity-care, and psychological distress during pregnancy. It was determined that women who made preparations for their pregnancy experienced more stress related to their babies (baby's health, baby's identity and care), psychological status in pregnancy, prenatal and postnatal social support, and body image.

Preconception care utilization: Self-report versus claims-based measures among women with Medicaid.

The objective of this study is to compare self-reported preconception care utilization (PCU) among Medicaid-covered births to Medicaid claims. We identified all Medicaid-covered births to women ages 15-45 in 26 states in the year 2012 among the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey and Medicaid Analytic eXtract (MAX) claims data, and identified preconception services in the latter using diagnosis codes published by Health and Human Services' Office of Population Affairs. We fit mixed-effects logistic regression models for the probability of PCU on sociodemographic factors (age, race, and ethnicity) and clinical diagnoses (depression, diabetes, or hypertension), separately for each dataset. Among 652,929 women delivering in MAX, 28.1% received at least one claims-based preconception service while an estimated 23.6% (95% CI 22.1-25.3) of PRAMS respondents reported receiving preconception care. Adjusting for age, chronic diseases, and state, PCU rates in both MAX and PRAMS were higher for non-Hispanic Black versus non-Hispanic White women (OR 1.51, 95% CI 1.49-1.54 and OR 2.05, 95% CI 1.60-2.62, respectively). Adjusting for differences in age, race and ethnicity, and state, PCU rates were higher for patients with diabetes (OR 1.34, 95% CI 1.29-1.40 and OR 1.82, 95% CI 1.16-2.85) or hypertension (OR 1.22, 95% CI 1.18-1.27 and OR 1.85, 95% CI 1.41-2.44). While Hispanic and Asian women were also more likely to report PCU than their non-Hispanic White counterparts (OR 2.07, 95% CI 1.53-2.80 and OR 3.37, 95% CI 2.28-4.98), they were less likely to have received it (OR 0.74, 95% CI 0.73-0.75 and OR 0.65, 95% CI 0.63-0.67). In conclusion, comparing self-report to claims measures of PCU, we found similar trends in the differences between non-Hispanic Black and White women, and between those with vs. without diabetes and hypertension. However, the two data sources differed in trends in other racial/ethnic groups (differences between Hispanic vs. non-Hispanic White women, and between Asian vs. non-Hispanic White women), and in those with vs. without depression. This suggests that while Medicaid claims can be a useful tool for studying preconception care, they may miss certain types of care among some sub-groups of the population or be subject to reporting differences that are hard to surmise. Both data sets have potential benefits and drawbacks as research tools.

Preconception care, prenatal care, and postpartum bonding in women with substance use

BackgroundThe status of care in the preconception and pregnancy periods in women who use substances can have an impact on maternal and neonatal health. This study aimed to assess the provision of preconception care, prenatal care, and postnatal mother-to-child bonding among pregnant women who use substances. MethodsAn ambidirectional cohort study was conducted, involving 69 pregnant women who reported substance use and had it confirmed using a ten-parameter panel kit (M10T) manufactured by Hannan Teb Pars Company. These women were selected from a referral maternity hospital between January and December 2020, using a convenience sampling method. Sociodemographic information, obstetric and medical history, and information about preconception and prenatal care were collected. All maternal and neonatal outcomes were recorded from the time of admission to the time of discharge for both the mothers and their neonates. Neonatal abstinence syndrome and mother-to-child bonding were assessed using modified Finnegan's neonatal abstinence tool and a postpartum bonding questionnaire, respectively. The data were analyzed using descriptive and inferential tests using SPSS software version 22. ResultThe mean age of the women was 32.8 ± 5.7 years. The mean duration of substance use was 5.1 ± 3.5 years. 48% of the pregnancies were reported as unwanted. A total of 94.2% and 50.7% of pregnant women did not receive preconception care and prenatal care, respectively. There was no association between pregnancy wantedness and receiving preconception care (P = 0.287), but a significant association was observed for prenatal care (P < 0.001). 31% of the mothers experienced a mother-to-child bonding disorder, with 75% of those who had unwanted pregnancies reporting such a disorder. ConclusionThe findings of this study indicate that the majority of pregnant women who use substances did not receive preconception care, and prenatal care was inadequate with fewer visits than recommended. One-third of the pregnant women who use substances experienced a mother-to-child bonding disorder. It was also observed that women with unwanted pregnancies had poorer perinatal care and mother-to-child bonding.

Pregnancy Outcomes in Women with Sickle Cell Disease (SCD): A Tertiary Centre Retrospective Study in Nigeria

Background: Sickle cell disease is the most common inherited condition. Due to recent advances in medical care for patients with sickle cell anaemia, more women with SCD are able to survive up to the reproductive age group. This has given rise to a higher number of pregnant women with SCD. It results in increased fetal and maternal risks due to the metabolic demands, hypercoagulable state and vascular stasis often associated with pregnancy. It has therefore become imperative to explore what progress has been made over the last decade as well as what can be done to achieve the best outcome in these women. &#x0D; Methods: This was a retrospective study of women with SCD who accessed antenatal care (ANC) at the Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi over a ten year period. Folder numbers were obtained from the obstetrics clinic and thereafter the folders were assessed and data retrieved using a checklist. Data analysis was done using SPSS 24.&#x0D; Results: The prevalence of sickle cell disease among pregnant women in this centre was 0.03%. All the women had the HbSS variants. The mean age of the subjects was 28.3 ± 5.6years. Majority of the women were gainfully employed. The mean gestational age at booking was 26 9.5 weeks. Half of the neonates had fetal distress at birth. Commonest maternal complication was anemia (100%) followed by vaso-occlusive crisis (89%). Eighty nine percent of the women were delivered by emergency caesarean section prior to 37 weeks gestational age. Preterm birth and fetal distress were the commonest neonatal complications.&#x0D; Conclusion: The study revealed that pregnancy associated with sickle cell disease still carries high maternal and fetal morbidity in this environment. Majority of the women with SCD in pregnancy did not receive preconception care and also did not commence their ANC early enough. There is need to educate women with SCD on the need for preconception care to ensure optimization of health prior to conception. They should also book early enough to facilitate close fetal monitoring throughout pregnancy.

Receiving Preconception Care Status of Pregnant Women and Related Factors

Objective: Preconception care is the provision of health interventions for parents before conception occuring. Physicians are not interested in preconception care as antenatal care in Turkey. This is one of the significant barrier for mother and infant health. We aimed to research receiving preconception care status of couples and preconception care related factors among pregnants. Methods: This was a cross-sectional study. Pregnant women (n=527) were selected with simple random sampling method and a questionnaire was filled out to them in our clinic. Data were analyzed with chi-square and student t-tests. Statistical significance level was accepted as P&lt;0.05. Results: 45.8% (n=233) of pregnants, and 17.7% (n=89) of husbands received preconception care. 59.6% (n=139) of husbands did not receive preconception care whose wives received preconception care. 100% (n=89) of pregnants received preconception care whose husbands received preconception care. 88.8% of pregnants thought necessity of receiving preconception care for women, and 69.8% for men. The major factor affecting to receive preconception care was planned pregnancy. To receive preconception care of men, to be university graduates were seen positive factors affecting planned pregnancy. Preconception care ensured by family physicians were analyzed in terms of main components of preconception care. Conclusion: The rate of receiving preconception care of parents was low. The level of receiving preconception care was associated with planned pregnancy and high education level of parents. It was shown family physicians do not evaluate the patients enough. Parents should be evaluated in terms of preconception care together.

Knowledge and Utilization of Preconception Care Services Among Pregnant Women Attending Antenatal Care at The Korle Bu Teaching Hospital

Objectives: Our study explores the knowledge, perceived importance, utilization, and barriers to preconception care services among pregnant women attending antenatal care in Accra, Ghana.Design: This is a descriptive cross-sectional survey design.Patients and Methods: Participants are pregnant women receiving antenatal care at the Korle-Bu Teaching Hospital in Accra, Ghana.Interventions and Outcome Measures: Participants completed a questionnaire on demographics and their knowledge, perceived importance, utilization, and barriers to preconception care services.Results: Of 120 participants, 71.7% (n=86) had not heard of preconception care, 76.7% (n=92) did not know any elements involved in preconception care, and 27.5% (n=33) were able to select the appropriate definition. One third of participants (39.2%, n=47)viewed preconception care as important. Only 15.8% (n=19) had personally utilized preconception care; most common components received were folic acid supplementation and management of anaemia. Of those who utilized preconception care, 100% felt the carewas beneficial. 21.1% faced a barrier in accessing care, including cultural beliefs, religious beliefs, and lack of time. The majority of all participants (n=75, 62.5%) felt that public education about preconception care could help overcome the barriers.Conclusions: We demonstrate a significant gap in knowledge and awareness of preconception care among pregnant women in Ghana. Women who do receive preconception care have good knowledge about the importance of the care, and universally feel that the care was beneficial. This highlights the importance of public education and healthcare provider counselling on the role, components, and benefits of preconception care.

Interconception Health: Improving Equitable Access to Pregnancy Planning.

Challenges remain with the implementation of preconception care, as many women do not plan their pregnancies and clinicians do not initiate preconception consultations. However, the interconception period may present a more opportune time to address health issues that impact on pregnancy outcomes and may influence future conceptions. It is also an important time to focus on pregnancy complications that may influence a person's health trajectory. This review discusses the evidence pointing to a need for greater attention on interconception health and focuses on five areas of care that may be particularly important in affecting equitable access to good care before a subsequent pregnancy: interpregnancy intervals, contraception, weight, nutrition, and gestational diabetes follow-up. Several programs internationally have developed models of care for interconception health and this review presents one such model developed in the United States that explicitly seeks to reach vulnerable populations of women who may otherwise not receive preconception care.

Does preconception care make a difference to pregnancy outcomes? A quasi-experimental, mixed-methods study

BackgroundPreconception care comprises a set of prevention and management interventions that aim to identify and modify risks to a woman's health or pregnancy outcome by emphasising factors that must be acted on before or early in pregnancy. This study aimed to ascertain the effect of the preconception care programme offered at UN Relief and Works Agency primary health-care centres in Gaza, Relief and Works Agency, on pregnancy outcomes. MethodsA quasi-experimental, mixed-methods study was done between Aug 16, 2018, and April 30, 2019. A stratified sampling process resulted in the selection of five of 22 UN Relief and Works Agency primary health-care clinics in Gaza, from which a sample of women was selected by the convenience method. A purposive sample of 11 key informants were interviewed. 60 beneficiaries and non-beneficiaries of preconception care also participated in focus group discussions. A structured interview questionnaire and records review were used for the quantitative study, and a semi-structured protocol was used for the qualitative study. Quantitative data were analysed with SPSS version 21.0 and an open coding thematic technique was used to analyse the qualitative data. The protocol of this study was approved by the Gaza Field Office and headquarters of the UN Relief and Works Agency and by the Al Quds University and was given ethical permission by the Palestinian Helsinki committee. All participants provided written informed consent. Findings800 women (400 who received preconception care and 400 controls) were included in the analysis. 188 (47%) of recipients first learned about the service through midwives. 176 (44%) of recipients registered for the service because they were planning to get pregnant. Regarding preconception care activities, 288 (72%) of recipients indicated that they received health advice, 396 (99%) were screened for hypertension, diabetes, and dental and breast problems and given folic acid, and more than 328 (82%) of recipients were counselled about its importance. 368 (92%) of recipients of preconception care took folic acid before conception, compared with 60 (15%) of non-recipients. 232 (58%) of recipients of preconception care and 268 (67%) of non-recipients had complications during their latest pregnancy, including genitourinary tract infection and anaemia. The percentage of women who delivered via caesarean section was 100 (25%) of recipients and 72 (18%) of non-recipients. 92 (23%) of recipients of preconception care and 128 (32%) of non-recipients had complications during their last delivery, especially bleeding. 72 (64%) of recipients and 268 (67%) of non-recipients had a full-term pregnancy. The mean birthweight of babies was 3274·5 g among recipients and 3225·4 g among non-recipients (p=0·2). InterpretationOur study showed that providing preconception care promotes positive maternal outcomes, yet further enhancement is needed. Targeting recipients of service, improving staff communication, informing and counselling prospective mothers, and ensuring compliance with technical instructions are areas that require further attention, as is strengthening monitoring and supervision. FundingNone.

Preconception Risk Factors and Preconception Care Practices in Turkish Women Sample

Introduction: The aim of the study was to evaluate the preconception risk factors that may adversely affect pregnancy outcomes, and preconception care practices.&#x0D; Methods: A descriptive study was completed with 359 women. The data were collected with a questionnaire that was drawn up by the researchers.&#x0D; Results: Findings demonstrated that preconception risk factors were advanced age (20.6%), smoking (23.1%), existence of a chronic illness (23.6%) and being overweight (26.7%). Applied to a health institution to receive preconception care was 12.3 %. The most common preconception care practices were the use of folic acid (45.4%) and applying to the doctor for reorganization of the treatment for chronic illness (41.2%). &#x0D; Discussion: The data showed that women had preconceptional risk factors and did not receive adequate preconceptional care. Women need to be provided with awareness on preconception risk factors. Policies should be developed to increase the frequency of women receiving preconception care.

Preconception Care Utilization among Childbearing Women in South-East Nigeria

Adverse pregnancy outcomes remain a challenging health problem in Nigeria. Before conception, couples need to utilize preconception care which is meant to address most of the reproductive health risks. However, the use of this service and its determinants is not well investigated globally. This Cross-sectional study was aimed at assessing the utilization of preconception care and its determinants among mothers in South-East Nigeria. Pre-tested and validated structured Questionnaire on Preconception Care Utilization was used to collect data from 350 postnatal women who were systematically selected from 33 sampled health facilities. Data were collated and entered into SPSS version 20. Binary logistic regression was used to determine the association between the demographic characteristics of the mothers and the utilization of preconception care. Statistical significance was set at p&lt;0.05. Results show that only 23.4% of the mothers utilized preconception care. Parity, employment status, and pregnancy intention were significantly associated with preconception care utilization. The odd of utilizing preconception care were 60.2% lower among multiparous women than primiparous women. Working-class mothers were more than 70% less likely to utilize preconception care than mothers who were not employed. Mothers whose pregnancy was intended were 3.4 times more likely to utilized preconception care than mothers whose pregnancy was unintended. Health facilities should establish functional clinics with the availability of evidence-based guidelines to improve uptake of preconception care. Health care professionals should intensify their efforts in encouraging women to receive preconception care.

Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial.

BackgroundThe provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures.ObjectiveThe goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India’s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications.MethodsA nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed.ResultsThe proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024.ConclusionsThrough preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes.Trial RegistrationClinical Trials Registry–India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836International Registered Report Identifier (IRRID)PRR1-10.2196/28148

Pre-pregnancy and prenatal care risk factors for spontaneous premature delivery in Western Uganda: a hospital based unmatched case-control study

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;We aimed to establish pre-pregnancy and prenatal care risk factors for spontaneous premature delivery at Kampala international university teaching hospital (KIUTH) so as to enable us draw a platform upon which specific interventions can be formulated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a hospital based unmatched case-control study conducted in the months of March to June 2019. A total of 110 cases and 330 controls admitted at KIUTH maternity and postnatal units were enrolled into the study. Interviewer administered questionnaires and respondent’s medical records were used to collect data. Chi square test and multiple logistic regression analysis were performed to establish the risk factors for spontaneous premature delivery at this facility. All data analyses were done using SPSS statistics version 20.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nulliparity, previous premature delivery, history of premature rupture of membranes, previous cervical procedures, history of not having received preconception care, urinary tract infections during pregnancy and maternal obesity were independently associated with spontaneous premature delivery at this hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Guided by these factors, a high index of suspicion for spontaneous premature delivery among all pregnant women attending prenatal care is vital towards ameliorating this obstetric complication at KIUTH.&lt;/p&gt;

The preferences and expectations of married women receiving preconception care in Iran: a qualitative study

ABSTRACT Preconception care (PCC), as an essential strategy in continuity of the care approach for women, could reduce maternal and child mortality. Women’s expectations from healthcare providers regarding PCC are different based on their knowledge, experiences and culture. The purpose of this study was to explore Iranian women’s preferences and expectations regarding PCC. In this qualitative content analysis 22 married women with intention to become pregnant were recruited from 22 healthcare centers in Mashhad, Iran, using purposive sampling. Data were collected through semi-structured in-depth interviews from March to October 2014. Interviews were transcribed verbatim and analyzed using a conventional content analysis approach. The main expectation of women regarding PCC was “being supported and receiving continuing care”. This overarching theme consisted of five categories including continuity of care, couple-centered care, establishing effective communication, accessibility to preconception services and access to competent professionals. Women highlighted their expectations as the need of support and to receive continuing healthcare. They requested PCC for couples and emphasized the importance of the health professional’s competency as well as access to information and services of PCC. Women’s experiences manifested several areas within which changes could be applied to improve the quality of preconception care.

Patient Screenings for Preconception Health Interventions at a Community Pharmacy.

Preconception health refers to health before pregnancy and involves addressing risk factors that can negatively impact either a patient or future pregnancy. Pharmacists can play an essential role in screening for and managing patients’ risk factors to optimize pregnancy outcomes. The primary objective of this study is to determine whether preconception health screenings in community pharmacy settings identify opportunities for preconception health services, particularly pharmacy-based interventions. The secondary objectives are to describe the preconception health status of community pharmacy patients and their interest in receiving preconception care services by a clinical pharmacist in a community pharmacy setting. Two independent pharmacies conducted a pilot project where people were invited to complete a health screening form that evaluated their preconception health. Participants received a personalized health report with an invitation to meet with the clinical pharmacist for services related to identified opportunities, such as contraception and immunizations. Retrospective analysis was conducted for data collected from 43 women during the patient screening effort in three community pharmacy settings (two independent community pharmacy locations and one neighborhood pharmacy outreach event). Nearly all participants (n = 42, 98%) had at least one opportunity identified to receive preconception care services, with the majority related to their alcohol use (60%). A majority of participants (56%) indicated an interest in learning more about preconception services offered at the pharmacy, but only 19% wanted to schedule an appointment with a pharmacist. Thus, there is an apparent need and opportunity for utilization of preconception health services at the pharmacy.

46 - Improving Preconception Counselling in Women With Diabetes

Diabetes Canada guidelines suggest that women with diabetes should receive preconception care from their diabetes health-care team. Studies have revealed that rates of preconception counselling vary from 30-70%. We assessed the rate of preconception counselling in women with diabetes at an academic endocrinology clinic, and designed and implemented a quality improvement initiative to improve preconception counselling rates.

Nursing Practice Strategies for Prenatal Care of Homeless Pregnant Women

Women who are homeless are less likely to receive preconception care or prenatal care in the first trimester, and they tend to have fewer prenatal visits overall than their housed counterparts. Homelessness during pregnancy can increase the risk for many maternal, fetal, and neonatal complications. Barriers to proper prenatal care can be categorized as logistical, psychosocial, intellectual, and attitudinal. Although all women face potential barriers to optimal care, women who are homeless are particularly vulnerable and experience these barriers to a greater degree. Nursing strategies for prenatal care of homeless pregnant women include therapeutic communication, focused assessment, and upstream interdisciplinary approaches.

PRECONCEPTIONAL CARE RECEIVING RATES OF TURKISH PREGNANT WOMEN, INFLUENCING FACTORS AND THE QUALITY OF THE CARE RECEIVED

The aim of the study was to estimate the rates of preconception care in Turkish pregnant women, the affecting factors and the quality of care. The cross-sectional study was carried out in the clinics of Department of Obstetrics and Gynecology of a State Hospital in the east of Turkey. Between the February 2017 and July 2017, 1050 pregnant women became the samples of the study. The received preconception care rate was 17.3%.When the quality of the received preconception care; From the components of the preconception care, it was identified that the order of the most frequently asked topics are; The ages of the mother and father (68.1%), past pregnancy status (91.8%) and delivery status (84.1%), the presence of a systemic disease such as DM or HT (%74.2), the presence of a drug that must be used consistently (63.7%), the presence of a contagious disease (47.8%) and tetanus vaccination (33.5%), consanguinity with husband (72%), the status of smoking and alcohol consumption (64.3%). It was determined that the folic acid tablets (85.2%) were prescribed the most in the antenatal health supplement component. The rate of preconception care in pregnant women was very low and it can be said that the quality of received care was moderately good.

Diabetes and Pregnancy

Diabetes and Pregnancy

Prevalence of Pre-Pregnancy Risk Factors and its Relationship with Preconception Care in Isfahan- Iran

Background Preconception care means interventions required for maternal and fetal health care and detection of pre-pregnancy risk factors. Some risk factors that have a significant effect on the outcome of pregnancy can be detected and controlled before pregnancy. The present study aimed to determine the prevalence of pre-pregnancy risk factors, and its relationship with preconception care in Isfahan-Iran. Materials and Methods This descriptive study was a cross-sectional research which was conducted with multi-stage sampling (stratified and cluster) from April to May 2016 on 702 women giving birth in hospitals in Isfahan (Iran). Data collection tool was a researcher made questionnaire and data were analyzed using SPSS software, descriptive statistics and chi-square test. Results The results showed that, the interval between current pregnancy with a previous pregnancy less than 4 years) 22.8%), abnormal weight (13%), sexually transmitted infections (11.3%), thyroid disorders (11 % ), and history of hospitalization of infants in the intensive care unit (11.1%), were the highest pre-pregnancy risk factors reported. There was a significant positive correlation between thyroid disorder and polycystic ovary (P<0.05). Also, a significant negative correlation was observed between interval less than 4 years between two maternal pregnancies, and receiving preconception care (P<0.05). Conclusion Results of this study showed that some of the risk factors (such as the interval less than 4 years between two pregnancies, abnormal weights and sexual infections) that generally affect pregnancy outcome, exist in women before pregnancy. Since many of these factors are easily identifiable before pregnancy, health planners and implementers need to pay special attention to this issue and identify people with these factor with screening programs before pregnancy.

The Association Between Preconception Care Receipt and the Timeliness and Adequacy of Prenatal Care: An Examination of Multistate Data from Pregnancy Risk Assessment Monitoring System (PRAMS) 2009-2011.

Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009-2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes.