Table 1.
Panel Recommendations and Actions
| Recommendation 1. Individual responsibility across the lifespan. Each woman, man and couple should be encouraged to have a reproductive life plan. |
| Action Steps |
| • Develop, evaluate, and disseminate reproductive life planning tools for women and men in their childbearing years, respecting variations in age; literacy, including health literacy; and cultural/linguistic contexts |
| • Conduct research leading to development, dissemination, and evaluation of individual health education materials for women and men regarding preconception risk factors, including materials related to biomedical, behavioral, and social risks known to affect pregnancy outcomes |
| Recommendation 2. Consumer awareness. Increase public awareness of the importance of preconception health behaviors and preconception care services by using information and tools appropriate across various ages; literacy, including health literacy; and cultural/linguistic contexts |
| Action Steps |
| • Develop, evaluate, and disseminate age-appropriate educational curricula and modules for use in school health education programs |
| • Integrate reproductive health messages into existing health promotion campaigns (e.g., campaigns to reduce obesity and smoking) |
| • Conduct consumer-focused research necessary to develop messages and terms for promoting preconception health and reproductive awareness |
| • Design and conduct social marketing campaigns necessary to develop messages for promoting preconception health knowledge and attitudes, and behaviors among men and women of childbearing age |
| • Engage media partners to assist in depicting positive role models for lifestyles that promote reproductive health (e.g., delaying initiation of sexual activity, abstaining from unprotected sexual intercourse, and avoiding use of alcohol and drugs) |
| Recommendation 3. Preventive visits. As a part of primary care visits, provide risk assessment and educational and health promotion counseling to all women of childbearing age to reduce reproductive risks and improve pregnancy outcomes |
| Action Steps |
| • Increase health provider (including primary and specialty care providers) awareness regarding the importance of addressing preconception health among all women of childbearing age |
| • Develop and implement curricula on preconception care for use in clinical education at graduate, postgraduate, and continuing education levels |
| • Consolidate and disseminate existing professional guidelines to develop a recommended screening and health promotion package |
| • Develop, evaluate, and disseminate practical screening tools for primary care settings, with emphasis on the 10 areas for preconception risk assessment (e.g., reproductive history, genetic, environmental risk factors) |
| • Develop, evaluate, and disseminate evidence-based models for integrating components of preconception care to facilitate delivery of and demand for prevention and intervention services |
| • Apply quality improvement techniques (e.g., conduct rapid improvement cycles, establish benchmarks and brief provider training, use practice self-audits, and participate in quality improvement collaborative groups) to improve provider knowledge and attitudes, and practices and to reduce missed opportunities for screening and health promotion |
| • Use the federally funded collaboratives for community health centers and other FQHC to improve the quality of preconception risk assessment, health promotion, and interventions provided through primary care |
| • Develop fiscal incentives for screening and health promotion |
| Recommendation 4. Interventions for identified risks. Increase the proportion of women who receive interventions as follow-up to preconception risk screening, focusing on high priority interventions (i.e., those with evidence of effectiveness and greatest potential impact) |
| Action Steps |
| • Increase health provider (including primary and specialty care providers) awareness concerning the importance of ongoing care for chronic conditions and intervention for identified risk factors |
| • Develop and implement modules on preconception care for specific clinical conditions for use in clinical education at graduate, postgraduate, and continuing education levels |
| • Consolidate and disseminate existing professional guidelines related to evidence-based interventions for conditions and risk factors |
| • Disseminate existing evidence-based interventions that can be used in primary care settings (e.g., brief interventions for alcohol misuse and smoking) |
| • Develop fiscal incentives (e.g., pay for performance) for risk management, particularly in managed care settings |
| • Apply quality improvement techniques and tools (e.g., conduct rapid improvement cycles, establish benchmarks, use practice self-audits, and participate in quality improvement collaborative groups) |
| Recommendation 5. Interconception care. Use the interconception period to provide additional intensive interventions to women who have had a previous pregnancy which ended in adverse outcome (e.g., infant death, fetal loss, birth defects, low birthweight or preterm birth) |
| Action Steps |
| • Monitor the percentage of women who complete postpartum visits (e.g. using HEDIS measures for managed care plans and Title V Maternal Child Health Block Grant state measures), and use these data to identify communities of women at risk and opportunities to improve provider follow-up |
| • Develop, evaluate, and replicate intensive evidence-based interconception care and care coordination models for women at high social and medical risk |
| • Enhance the content of postpartum visits to promote interconception health |
| • Use existing public health programs serving women in the postpartum period to provide or link to interventions (e.g., family planning, home visiting, and WIC) |
| • Encourage additional states to develop preconception health improvement projects with funds from the Title V Maternal Child Health Block Grant, Prevention Block Grant, and similar public health programs |
| Recommendation 6. Prepregnancy check up. Offer, as a component of maternity care, one prepregnancy visit for couples and individuals planning pregnancy |
| Action Steps |
| • Modify third party payer rules to permit payment for one prepregnancy visit per pregnancy, including development of billing and payment mechanisms |
| • Consolidate existing professional guidelines to develop the recommended content and approach for such a visit |
| • Educate women and couples regarding the value and availability of prepregnancy planning visits |
| Recommendation 7. Health insurance coverage for women with low incomes. Increase public and private health insurance coverage among women with low incomes to improve access to preventive women's health, preconception, and interconception care |
| Action Steps |
| • Improve the design of family planning waivers by permitting states (by federal waiver or by creating a new state option) to offer interconception risk assessment, counseling, and interventions along with family planning services. Such policy developments would create new opportunities to finance interconception care |
| • Increase health coverage among women who have low incomes and are of childbearing age by using federal options and waivers under public and private health insurance systems and the State Children's Health Insurance Program |
| • Increase access to health-care services through policies and reimbursement levels for public and private health insurance systems to include a full range of clinicians who care for women |
| Recommendation 8. Public health programs and strategies. Integrate components of preconception health into existing local public health and related programs, including emphasis on interconception interventions for women with previous adverse outcomes |
| Action Steps |
| • Use federal and state agency support to encourage more integrated preconception health practices in clinics and programs |
| • Provide support for CDC programs to develop, evaluate, and disseminate integrated approaches to promote preconception health |
| • Analyze and evaluate the preconception care activities used under the federal Healthy Start program and support replication projects |
| • Convene or use local task forces, coalitions, or committees to discuss opportunities for promotion and prevention in preconception health at the community level |
| • Develop and support public health practice collaborative groups to promote shared learning and dissemination of approaches for increasing preconception health |
| Recommendation 9. Research. Increase the evidence base and promote the use of the evidence to improve to preconception health |
| Action Steps |
| • Prepare an updated evidence-based systematic review of all published reports on science, programs, and policy (e.g., through the Agency for Healthcare Research and Quality) |
| • Encourage and support evaluation of model programs and projects, including integrated service delivery and community health promotion projects |
| • Conduct quantitative and qualitative studies to advance knowledge of preconception risks and clinical and public health interventions, including knowledge of more integrated practice strategies and interconception approaches |
| • Design and conduct analyses of cost-benefit and cost-effectiveness as part of the study of preconception interventions |
| • Conduct health services research to explore barriers to evidence-based and guidelines-based practice |
| • Conduct studies to examine the factors that results in variations in individual use of preconception care (i.e., barriers and motivators that affect health-care use) |
| • Support activities to translate research into clinical practice and public health action |
| Recommendation 10. Monitoring improvements. Maximize public health surveillance and related research mechanisms to monitor preconception health |
| Action Steps |
| • Apply public health surveillance strategies to monitor selected preconception health indicators (e.g., folic acid supplementation, smoking cessation, alcohol misuse, diabetes, and obesity) |
| • Expand data systems and surveys (e.g., PRAMS and NSFG) to monitor individual experiences related to preconception care |
| • Use geographic information system techniques to target preconception health programs and interventions to areas where high rates of poor health outcomes exist women of reproductive age and their infants |
| • Use analytic tools (e.g., PPOR) to measure and monitor the proportion of risk attributable to the health of women before pregnancy |
| • Include preconception, including interconception, health measures and population-based performance monitoring systems (e.g., in national and state Title V programs) |
| • Include a preconception measure in the Healthy People 2020 objectives |
| • Develop and implement indicator quality improvement measures for all aspects of preconception care. For example, use HEDIS measures to monitor the percentage of women who complete postpartum visits |