Preconceptional Wellness as a Routine Objective for Women's Health Care: An Integrative Strategy

doi:10.1177/0884217503255302

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 32, Issue 4, July 2003, Pages 550-556

https://doi.org/10.1177/0884217503255302 Get rights and content

Preconceptional health promotion should not be approached as an isolated activity. Instead, a new approach to women's wellness is needed. Rather than targeting care to women based on their pregnancy status or desires, health promotion and disease prevention should be integrated into a continuum of care throughout the life cycle. When care for women is viewed as an integrated continuum approach to health, rather than as a series of episodic events, higher levels of women's wellness will be achieved. This approach is likely to result in healthier women, pregnancies, and offspring. These outcomes are consistent with the goals of preconceptional health promotion. Using several case illustrations, this article highlights the benefits of integrating care into a continuum model.

Section snippets

The Current Approach to Care: Three Cases

Our contemporary approach to health care for women of reproductive age is often episodic, uncoordinated, inefficient, and ineffective. Women are approached as pregnant or not pregnant, with little effort to integrate care between these states. Major health care problems identified during pregnancy and birth may not be addressed again until the next pregnancy. Health issues of potential consequence for the health of a future pregnancy or offspring may not be addressed until after pregnancy is

Integrative Frameworks

Walker and Tinkle (1996) proposed an integrative science of women’s health that brings together childbearing considerations with women’s general health. These authors called for a comprehensive framework for health assessment and health maintenance across the life spans of all women and identified two important dimensions of this approach. The first dimension incorporates the breadth of sciences that study women’s health, such as biology, sociology and psychology into a “whole woman”

Care of Women From Menarche to Menopause

Figure 2 illustrates a proposed continuum model. In the continuum model, providers build on what is learned about a woman’s health at each encounter with the health care system to design a plan of care based on the woman’s evolving and integrated health profile. The sum of the knowledge gained from previous encounters informs a plan of care for health promotion, disease prevention, health education, and specific treatment recommendations. Providers using this model aim to promote the health of

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Preconceptional care is a set of interventions, aimed to identify and modify medical, behavioral, and social risks to a woman's health and her pregnancy outcome, prior to conception. Diagnosing and treating some of the common noncommunicable diseases (NCDs) may have an impact on pregnancy outcome. Ample time should be allowed to properly intervene in some of the following situations: hypertension, diabetes, obesity, systemic lupus erythematosus, thyroid disease, anemia, epilepsy, asthma, and cardiac disease. Diabetes mellitus and obesity are common NCDs, with proven efficacy for preconceptional care, for both maternal and perinatal outcome. These primary components of the metabolic syndrome, if properly treated prior to pregnancy, will prevent long-term hazards for the mother, her children, and the next generations, by providing in utero primary prevention of NCDs.
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Despite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician–gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients.
A questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network.
A 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance (“private group”) and the 105 reported providing care to mostly publicly insured or uninsured patients (“non-private group”) were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18.
Results reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.
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Citation Excerpt :
For example, gender-sensitive services for women, including breast cancer screening, osteoporosis screening, screening for unique cardiovascular risk factors in women, fall-prevention interventions, screening for depression and cognitive impairment, as well as services to caregivers to prevent illness onset could be bundled in the wellness visit associated with welcoming older women to Medicare services. Twenty years of accumulating research and analyses provide a strong scientific foundation for encouraging preconception wellness as a routine component of healthcare for all women of reproductive potential (Centers for Disease Control and Prevention, 2006; Jack et al., 2008; Moos, 2003; Moos et al., 2008). The purpose of preconception care is primary prevention of many poor pregnancy outcomes: to deliver risk screening, health promotion, and effective interventions as a part of routine healthcare.
There has been a recent resurgence of interest in women's health as evidenced by several federal and international policy-shaping reports that will impact women's health services. These reports include the 2010 Affordable Care Act, the formation of the National Prevention Council and Strategy, the 2011 IOM report on clinical preventives services for women, and the World Health Organization strategic plan for 2010-2015. In this paper, we summarize and discuss these reports and discuss implications of enacting the suggested health policies. We highlight policy strategies and recommendations that will extend national and global recommendations to improve women's health and wellness across the lifespan and emphasize the urgent need for preventive services. We conclude this paper by detailing our broad recommendations for putting prevention into practice illustrated by specific recommendations related to unintended pregnancy prevention and management.
Meeting the National Health Goal to Reduce Unintended Pregnancy
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In spite of advances in health care, the rate of unintended pregnancy has not diminished.Healthy People 2020 and the Affordable Care Act of 2010 have promoted prevention as the most effective means of ensuring the health of the citizens of the United States.This shift in the national approach to the promotion of prevention holds the potential to appropriately address pregnancy planning from a comprehensive public health framework.
Evidence to Inform Policy, Practice and Education for Unintended Pregnancy Prevention and Management
2011, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing

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CLINICAL ISSUESPreconceptional Wellness as a Routine Objective for Women's Health Care: An Integrative Strategy

Section snippets

The Current Approach to Care: Three Cases

Integrative Frameworks

Care of Women From Menarche to Menopause

Obstetrics & Gynecology

Women's Health Issues

Journal of Obstetric, Gynecologic, and Neonatal Nursing

Primary and preventive care: Periodic assessments

Smoking cessation during pregnancy

Depression in women

Predicting preterm labour and birth: 12th Annual SPO Meeting No. 486

American Journal of Obstetrics and Gynecology

Improving preconception care

Journal of Reproductive Medicine

Preconceptional health care: A practical guide

Effectiveness in disease and injury prevention: Use of folic acid for prevention of spina bifida and other neural tube defects 1983–1991

Morbidity and Mortality Weekly Report

Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects

Morbidity and Mortality Weekly Report

American women's health care: A patchwork quilt with gaps

Journal of the American Medical Association

Unintended pregnancy in the United States

Family Planning Perspectives

Abortion patients in 1994–95: Characteristics and contraceptive use

Family Planning Perspectives

Low pregravid body mass index as a risk factor for preterm birth: Variation by ethnic group

Obstetrics & Gynecology

Preconception care: Maximizing the health of women and their newborns

Preventing low birthweight

Dietary reference intake: Folate, other B vitamins and choline

Preconception care of diabetes: Glycemic control prevents congenital anomalies

Journal of the American Medical Association

CLINICAL ISSUES
Preconceptional Wellness as a Routine Objective for Women's Health Care: An Integrative Strategy