Interconception Health Services for Women at High Risk for Adverse Pregnancy Outcomes: A Descriptive Study
Dean V. Coonrod *
Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, Arizona, USA and Department of Obstetrics and Gynecology, District Medical Group, Phoenix, Arizona, USA and Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Debra Welborn
Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, Arizona, USA
Rosie Casillas
Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, Arizona, USA.
Blanca-flor Jimenez
Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, Arizona, USA and Department of Obstetrics and Gynecology, District Medical Group, Phoenix, Arizona, USA.
Amber N. Sturgeon
Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, Arizona, USA and Department of Obstetrics and Gynecology, District Medical Group, Phoenix, Arizona, USA.
Kathie Records
College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.
Colleen Keller
College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.
*Author to whom correspondence should be addressed.
Abstract
Aims: To describe and present results of preconception care services aimed at underserved women who have experienced an adverse birth outcome.
Study Design: Retrospective descriptive study.
Place and Duration of Study: Sample: Maricopa Integrated Health System’s Internatal Clinic, a public safety-net hospital in Phoenix, Arizona USA, between March 2008 and October 2011.
Methodology: 102 women who have experienced a prior preterm birth or stillbirth currently enrolled in an “Internatal Clinic” where interconception and prenatal care is provided. The interventions included education by clinicians and trained support staff, support groups, a walking program to address physical activity, contraception, folic acid intake, dental care, overweight/obesity, mental health and substance use issues prior to a future pregnancy. Chart reviews were performed and a preconception health survey addressing knowledge (pre/post) and patient satisfaction were analyzed using descriptive and univariate statistics.
Results: Of current enrollees (N=102), 79% have been in the program for 12 to 18 months. 100% of those with mental health needs have had them addressed, 93% of those not desiring pregnancy are using contraception, 75% are consuming a folate supplement, 53% are engaging in regular exercise and 37% had oral health needs addressed despite no insurance coverage. Of the 102 patients, only 21% had a normal body mass index (18.5 to 24.9 kg/m2). Improvements in patient knowledge and attitudes were documented.
Conclusion: Women in our program had improved preconception knowledge, attitudes and behaviors.
Keywords: Preconception care, care coordination, primary care, birth outcomes, health disparities