"Preconception Care Is not a Luxury"By Fia Curley
Preconception health is only a worry for those trying to conceive. Or so nurse practitioner Mary M. Gottesman used to think.
"I really rehabilitated my thinking that when a girl enters puberty that is preconception," said Gottesman, associate professor of clinical nursing at Ohio State University's College of Nursing.
Now she thinks a huge awareness campaign is necessary for everyone – women, men and health professionals like her.
"If we have a campaign among primary providers and providers in training, I really believe we can make a difference in preconception health readiness," said Gottesman, past president of National Association of Pediatric Nurse Practitioners and author of several articles for the Journal of Pediatric Health Care.
With more than half of all pregnancies in the United States unplanned, physicians and public health officials are touting the benefits of preconception health care to improve birth outcomes and reduce infant mortality.
"It starts before birth and it goes from the cradle to the grave," said Kimberlee Wyche, M.D., MPH, director of the Bureau of Family, Youth and Infant Health for the Metro Nashville Davidson County Public Health Department in Tennessee. "It's really about well-woman's health and having a healthy society, because if your women are healthy, your babies are going to be healthy and your society will be healthy."
Preconception health is the step prior to prenatal care. Instead of putting the focus on the health of a pregnant woman or a father, the emphasis shifts to making sure a person is as healthy as possible before conception.
This can involve any number of things, according to Dr. Wyche.
From annual well-woman visits and healthy fruit and veggie-filled diets to having up-to-date vaccinations, Wyche believes every person should know their medical history, including whether or not the sickle cell trait runs in the family and how to manage chronic diseases.
Unchecked chronic diseases, such as diabetes, hypertension and high cholesterol can lead to pregnancy and birth complications and to miscarriages and preterm labor. They also can affect the health of the fetus.
Habits, such as smoking, drinking alcohol and taking illegal drugs are also harmful to a baby and should be avoided by both mom and dad.
"A large part of the partner's role is supporting the pregnant woman during her pregnancy. This means to stop smoking or it seems like: ‘Haha, I can do it and you can't'," said Gottesman.
Dr. Wyche sees a need to emphasize preconception health to males.
"Definitely, the issue of healthy young men is important," Dr. Wyche said. "In a lot of other cultures, pregnancy is seen as more of a community event. It's not just the woman who is pregnant, but the couple. I think incorporating opportunities to getting more information on responsible fatherhood is key."
"That's going to take a cultural shift and that's a lofty goal, but we did it with cigarettes and we did it with seatbelts," Wyche said.
And "lofty goals" can be especially difficult when communities have to face stark realities on a daily basis.
With daily struggles and negative influence from the media, Wyche said she believes the issue of preconception health needs to be hit from multiple angles, particularly with younger people.
"For older women, you really have to [market] it from the context of having a healthy baby," Wyche said. "For the ‘Millennials' and the ‘Nexters,' it's about ‘how do I benefit and what's in it for me?' They have a different kind of entitlement."
Gottesman agrees, noting that many mothers see having a baby as strictly a nine-month process.
"Many moms tell me they can't wait until they give birth so they can drink, smoke and eat [bad food] again," she said. "I think if we all just stopped and thought about this being a lifetime commitment, we'd all do a lot more pregnancy planning."
But the planning is rare when it comes to pregnancy, which can result in late entry into prenatal care, low birth weight and infant mortality, according to The National Campaign to Prevent Teen and Unplanned Pregnancy [PDF, 830KB]. Unplanned and unwanted pregnancies not only affect a child's future health, but the health of parents, as well, by leading to relationship conflict and turmoil within the home, according to a National Campaign study.
"Preconception care is not a luxury," says Nancy Green, M.D. As the medical director of the March of Dimes, Dr. Green is acutely aware of the difficult pregnancies and childhood illnesses associated with poor pregnancy planning. The March of Dimes estimates that 30 to 40 percent of birth defects are caused by medical, environmental, genetic, and psychosocial factors that could, to some degree, be prevented.
"Preconception care is a window of opportunity to optimize both partners' health, identify any risks and take the steps to reduce them," explains Dr. Green. Even the healthiest young couple should expect to heighten their level of self-care and physical readiness in the months before first trying to conceive."
And because more than 50 percent of pregnancies are unplanned, Wyche said "most of us should be on our best behavior for good health. Having healthy babies is a compelling reason for most of us and it doesn't matter if you have money or not."
Fia Curley is a writer for the OMHRC. Comments? E-mail: firstname.lastname@example.org
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