Health Indicators and Risks
Preconception

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Preconception Care Goals
The National Summit on Preconception Care, in conjunction with the CDC, formulated four goals in relation to preconception health.
  1. Improve the knowledge and attitudes and behaviors of men and women related to preconception health
  2. Ensure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions)
  3. Reduce risks indicated by a previous adverse pregnancy outcome through interventions during the inter-conception period, which can prevent or minimize health problems for a mother and her future children
  4. Reduce the disparities in adverse pregnancy outcomes
        (Kent, Johnson, Curtis, Richardson-Hood, & Atrash, 2006).

Health Risks of Pregnancy

  • Anemia
  • Depression (can be from hormone fluctuations)
  • Ectopic pregnancy
  • Fetal problems such as poor growth
  • Gestational diabetes, which may increase risk for Type II diabetes later
  • Pregnancy related hypertension
  • Hyperemesis gravidarum, severe persistent vomiting
  • Miscarriage, loss of fetus, can be associated with sepsis if products of conception are not fully expelled
  • Placenta previa, or malposition of placenta increasing risk of bleeding, abruption, possible fetal complications and need for cesarean section
  • Placental abruption, detachment of the placenta can cause life threatening hemorrhage and fetal demise
  • Preeclampsia or toxemia - syndrome of hypertension and kidney dysfunction usually after 20 weeks
  • Preterm labor - labor before 36 weeks; has health consequences for both mother and baby
        (WomensHealth.gov, n.d.)

High Risk Pregnancy

What is "high risk" pregnancy?
Pregnancy with a greater risk of complications for both mother and baby. 
Increased risks may be due to:
  • Young maternal age
  • Women over 35 years
  • Under or over weight
  • History of problems with previous pregnancies
  • Pre-existing conditions: high blood pressure, diabetes, autoimmune disorders, cancer, HIV
  • Pregnancies with multiples
There are tools available to assess for high risk pregnancy (see below)

Pregnancy - Maternal Health Indicators

According to the Centers for Disease Control and Prevention (2011), maternal health indicators are as follows:
  • Prepregnancy body mass index (BMI) - helps determine weight gain during pregnancy and birthweight;
  • Maternal weight gain / gestational weight gain - major determinant of birthweight and infant mortality and morbidity;
  • Anemia - of particular concern during the third trimester when iron deficiency anemia is most prevalent;
  • Parity - the number of previous pregnancies, not including the current pregnancy; impacts long term health status and birthweight;
  • Interpregnancy interval - amount of time between pregnancies, calculated as the number of months from end of last pregnancy to date of last menstrual period;  Short interpregnancy intervals place women at a nutritional risk and increased likelihood of adverse birth outcomes, such as small for gestational age, preterm or neonatal death;
  • Gestational diabetes - increases risk of delivering macrosomic infants and developing type II diabetes later in life;
  • Hypertension - chronic or pregnancy induced;  If hypertensive prior to pregnancy, may have fetal growth restriction and abruptio placentae;  Pregnancy induced hypertension (PIH) may cause preeclampsia, eclampsia, preterm delivery, slow fetal growth, abruptio placentae and fetal death;
  • Medical care - the month in which prenatal care was started for the current pregnancy;  Prenatal care started after the first trimester are at a high risk for poor pregnancy outcomes, such as premature infant, low birth weights or slow growth;
  • WIC enrollment - date in which the woman enrolled in WIC for current pregnancy; helps determine length of WIC exposure for the pregnancy, related to birth outcomes;
  • Multivitamin consumption - folic acid intake prior to pregnancy reduces neural tube defects; iron during pregnancy to prevent preterm delivery and low birthweight infant;
  • Smoking during pregnancy - active use of cigarettes increases the risk for low birthweight, spontaneous abortion, sudden infant death syndrome, long term growth and developmental issues; Monitoring includes three months prior to pregnancy, last three months of pregnancy and during the post partum period;
  • Smoking changes - history of smoking prior to pregnancy and ceased by first prenatal visit;  Women who smoke during the first and second trimesters are at risk for delivering a low birthweight infant; Women who quit smoking by their first prenatal visit reduce their risk of delivering a low birthweight infant; 
  • Smoking in household - exposure of tobacco contaminated air in home; Exposure to environmental tobacco had an increased risk of delivering a low birth weight infant or small for gestational age infant;
  • Drinking - use or consumption of alcohol during pregnancy; Daily consumption of more than six ounces of liquor (or equivalent) had a 1/5 chance of having a child with Fetal Alcohol Syndrome (FAS); Additional physical and / or neurological problems could occur with less exposure to alcohol; Similar to tobacco, drinking is evaluated three months prior to pregnancy and during the last three months of pregnancy;