Preconception Care in the Primary Care Setting

Approximately half of all pregnancies are unplanned. This statistic alone indicates the importance of preconception counseling for all women of childbearing age, regardless of pregnancy plans. The Center for Disease Control (CDC) recommends risk assessment and counseling for all women of childbearing age as part of primary care visits in order to improve pregnancy outcomes (www.cdc.gov). Primary care practitioners are in an important position to help improve maternal and fetal outcomes, however, most providers overlook giving patients this vital information. Most women prefer to get their information about preconception care from primary care providers, yet less than 40% of primary care providers actually provide preconception care (Files, David, & Frey, 2008). Though aware of the importance of preconception care, few primary care providers routinely ask patients about their pregnancy plans. Many providers have not had education or training in pregnancy or preconception topics since completing their clinical education and may feel unprepared to teach about this topic (Schwarz, Santucci, Borrero, Akers, Nikolajski, & Gold, 2009). Most initial prenatal visits do not occur until late 8-12 weeks into a woman's pregnancy. It has been found that the prenatal period does not provide enough time to address many of the maternal health problems and risk factors that could adversely affect the mother and/or the baby (Weisman et al, 2008). There is a missed opportunity in primary care to prevent adverse health outcomes in mothers and their fetuses, and a missed opportunity for education. A clear gap exists between what is expected of primary care providers and what is actually being delivered to patients. The objectives for this project were: to develop a handout addressing key preconception care topics for primary care providers to distribute to all women of childbearing age and to implement the handout in two different primary care offices. In addition, a provider guidebook was created that could be used as a reference should their patients have specific questions about topics addressed on the handout. Providers were trained on how to use the handout and the guidebook. A short questionnaire evaluating the effectiveness of the handout was given to the providers after approximately 4-6 weeks of use. Additionally, a link to a PDF copy of the handout was posted on Westminster College's Student Health Services website and Dr. Reed's Family Practice website. Access to the preconception health information on Westminster's website was evaluated through the use of a hit counter and compared to their overall health website usage. Provider feedback regarding the handout and overall access to the Westminster website demonstrated that there is a need for preconception education in the primary care setting