Preconception Care: Why Should We Care

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CDCs Preconception Health and Health Care
Initiative History and An Update
Hani K. Atrash, MD, MPH hka1_at_cdc.gov
Associate Director for Program Development
National Center on Birth Defects and
Developmental Disabilities And,The CDC
Select Panel on Preconception Care
The CDC/ATSDR Workgroup on
Preconception Care, and
2007 CityMatCH Urban MCH Leadership Conference
August 26 - 28, 2007, Denver, Colorado
"The findings and conclusions in this
presentation are those of the author and do not
necessarily represent the views of the Centers
for Disease Control and Prevention/the Agency
for Toxic Substances and Disease Registry"
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The Preconception Care Team

• Steering Committee
• CDC, HRSA/MCHB, ACOG, MOD, AMCHP, CityMatCH,
  Consultants
• Select Panel
• Representatives of partner organizations, subject
  matter experts
• CDC/ATSDR Workgroup
• Representatives of 22 programs (80 members)
• Workgroups (Clinical, Public Health, Consumer,
  Policy and Finance)
• Practitioners, members of select
• panel, members of CDC/ATSDR
• workgroup
• Pilot Urban Practice Collaborative

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Why Preconception Care

• Poor Pregnancy Outcomes Continue To Be At
  Un-acceptable Levels
• Women Enter Pregnancy At Risk For Adverse
  Outcomes
• There Is Consensus That We Must Act Before
  Pregnancy
• Intervening Before Pregnancy Will Help Improve
  Outcomes
• We currently intervene too late

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If you continue to do what you always did, You
will continue to get What You always got

Anonymous
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Paradigm Shift
From Anticipation and Management
to Health
Promotion and Prevention From Healthy
Mothers Healthy Babies
to Healthy Women
Healthy Mothers Healthy Babies
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Not a New Concept

• Aristotle, Problemata, 384-322 BCE Foolish,
  drunken, or harebrain women most often bring
  forth children like unto themselves
• William Potts Dewees, first American textbook on
  Pediatrics 1825 The physical treatment of
  children should begin as far as may be
  practicable, with the earliest formation of the
  embryo it will, therefore, necessarily involve
  the conduct of the mother, even before her
  marriage, as well as during her pregnancy.
• Domestically, starting in 1979 Reference in
  government and professional reports
• Internationally MCH and womens health meeting
  reports starting in the 1960s

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Why a CDC Preconception Health and Health Care
Initiative?

• Opportunities are missed
• New strategies are needed
• Facilitate collaboration
• Develop recommendations
• Identify and address obstacles and opportunities
  
• Clinical, Public health, Consumer, Policy
  Finance, Research

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Challenges to Implementation (2004)

• Absence of a national policy
• that supports implementation
• Lack of National/State/Local
• Model programs
• Lack of tools and practical guidelines for
  practice (Who does it, who gets it, how much,
  what is it, why do it, how to do it, where to do
  it, when to do it, etc?)
• Inadequate education of providers and consumers
• Lack of demonstrated practicality, feasiblity
  and effectiveness of preconception programs

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The CDC PCC InitiativeInitial Plan

• Make the scientific case Solidify the scientific
  evidence
• Make the business case
• Develop consensus within and outside CDC
• Develop recommendations and national policy
• Develop guidelines and tools for implementation
• Develop marketing strategies
• Implement recommendations
• Enhance knowledge and skills of providers
• Educate consumers

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The CDC PCC Initiative Timeline
9/06 Supplement
6/05 1st Summit
10/07 2nd Summit
5/06 Clinical, PH, Consumer Workgroup Meetings
6/04 CDC Workgroup
5/07 2nd Select Panel Meeting
1/06 Steering Committee Meeting
6/05 Select Panel Meeting
4/06 Recommendations
11/04 Meeting with Partners
3/07 Policy Finance Workgroup Meetings
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www.marchofdimes.com/california
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Partners
With CDCs Environmental Health, Birth Defects
and Developmental Disabilities, Chronic Disease,
Infectious Diseases, National Immunization
Program, Health Marketing, Health Statistics,
HIV, STD, and TB Prevention, Womens Health,
Genomics and Public Health
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Recommendations 1-5

• Recommendation 1. Individual responsibility
  across the life span
• Recommendation 2. Consumer awareness
• Recommendation 3. Preventive visits
• Recommendation 4. Interventions for identified
  risks
• Recommendation 5. Interconception care

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Recommendations 6-10

• Recommendation 6. Pre-pregnancy check ups
• Recommendation 7. Health coverage for low-income
  women
• Recommendation 8. Public health programs and
  strategies
• Recommendation 9. Research
• Recommendation 10. Monitoring improvements

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Steering Committee Meeting The Road Ahead

• Define contents
• Integrate existing guidelines
• Disseminate information
• Demonstrate effectiveness
• Explore means for financing
• Monitor practice
• Study association between womens
• health and pregnancy outcomes
• Conduct a cost study

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Implementation The Goals

• Changing consumer knowledge, attitudes, and
  practices
• Changing clinical providers knowledge,
  attitudes, and practices
• Change public health professionals knowledge,
  attitudes, and practices

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Strategies to Implement The Recommendations

• Workgroup Meetings
• June 27/28-2006
• Clinical
• Public Health
• Consumer
• March 2007
• Policy and Finance

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Strategies for Implementation

• Clinical guidelines and tools
• Consumer information
• Public health programs and strategies
• Monitoring and surveillance
• Research agenda
• Public policy and finance
• Professional education/training
• 8. Best practices
• Demonstration projects
• State and local initiatives

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Strategies for Implementation
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Strategies for Implementation
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Strategies for Implementation
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Strategies for Implementation
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Clinical Workgroup

• Developing a Curriculum for training clinical
  care providers
• Developing a uniform set of guidelines
• Developing a standard assessment tool
• Delivering lectures at various meetings and
  conferences
• Developing a clinical demonstration project and
  other research projects

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Public Health Workgroup

• Assessing existing screening tools
• Promoting education for public health students
  and workers
• Modifying existing surveys to include questions
  on preconception health and health care
• Evaluating preconception/interconception care
  activities under Healthy Start
• Implementing Public Health Practice
  Collaboratives in Los Angeles, Nashville and
  Hartford

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Consumer Workgroup/Other

• Consumer Workgroup
• Developing consumer messages with market research
• Conducting participatory action research with
  women at risk
• Other
• Speakers Bureau with over 30 volunteers
  available to speak about preconception care
• CDC and March of Dimes updated their websites to
  include more information about preconception care
• Members of the steering committee are supporting
  several states who started working on
  preconception care

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The CityMatCH Pilot Urban Practice Collaborative

• Acts on CDC Recommendation 8 Integrate
  components of preconception health into existing
  local public health and related programs,
  including emphasis on interconnection
  interventions for women with previous adverse
  outcomes
• Uses a practice collaborative model to promote
  adoption and integration of Preconception health
  recommendations among peers
• Encourages more integrated preconception health
  practices and policies in public health programs
  in urban settings

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CityMatCH Pilot Urban Practice Collaborative
Team Composition

• Led by the urban public health program (CityMatCH
  member is the health department)
• 5-person teams with expertise in
• community assessment/engagement
• prevention programming
• clinical practice
• policy development and
• systems integration of reproductive/womens
  health
• Each team has representatives from local March of
  Dimes, State MCH Director, local community
  organizations
• Each team will select a project to address
  preconception health in their community

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Team Hartford

• Smaller racial/ethnically diverse urban area in
  the Northeast
• Large Latina population
• Project Focus Integration of preconception
  health into existing MCH programs

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Team Los Angeles

• Large urban center with 1 of 4 US births
  occurring in the county
• Tremendous potential impact on maternal and
  infant health outcomes
• Project Focus Improve data and surveillance
  preconception health issues

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Team Nashville

• Mid-size, traditional Southern urban area with
  large Black population
• Project Focus Target special populations to
  address preconception health concerns of
  childbearing age women including young women with
  sickle cell disease trait

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Thank You!
Questions??? hka1_at_cdc.gov
www.cdc.gov/ncbddd