Improving Women's Preconceptional Health

Abstract

Purpose-Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child. This paper reports the first pretest-posttest results from a randomized trial of a unique, multidimensional, small group format intervention, Strong Healthy Women, designed to improve the health behaviors and health status of preconceptional and interconceptional women.Methods-Nonpregnant pre-and interconceptional women ages 18−35 were recruited in 15 lowincome rural communities in Central Pennsylvania (n = 692). Women were randomized in a ratio of 2-to-1 to intervention and control groups; participants received a baseline and follow-up health risk assessment at 14 weeks and completed questionnaires to assess behavioral variables. The analytic sample for this report consists of 362 women who completed both risk assessments. Outcomes include measures of attitudinal and health-related behavior change.Main Findings-Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes; greater intent to eat healthy foods and be more physically active; and greater frequency of reading food labels, physical activity consistent with recommended levels, and daily use of a multivitamin with folic acid. Significant dose effects were found: Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes, reading food labels, engaging in relaxation exercise or meditation for stress management, and daily use of a multivitamin with folic acid.Conclusions-The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity. These results show that these topics can be successfully addressed with pre-and interconceptional women outside the clinical setting in community-based interventions. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptRecent recommendations to improve preconception health and health care in the United States have inspired calls for innovative approaches to reduce adverse pregnancy outcomes, including strategies for improving women's health before they become pregnant (Haas et al., 2005;Korenbrot, Steinberg, Bender, & Newberry, 2002;Moos, 2004). The Centers for Disease Control and Prevention (CDC, 2006) recommends a multipronged strategy for improving women's health before pregnancy through greater access to clinical care, community-based health promotion programs, and a focus on individuals' health-related behavior. Addressing the latter 2 points, we developed the Strong Healthy Women intervention to improve healthrelated behaviors, attitudes, and health status among pre-and interconceptional women recruited in community settings (Downs et al., 2008). This paper reports the pretest-posttest results of a randomized trial of this unique multidimensional behavior change ...

Preconception health interventions delivered in public health and community settings: A systematic review

“…In total, 12 studies met the inclusion criteria for our search. [24][25][26][27][28][29][30][31][32][33][34][35] (See the Supplementary file, in the ARTICLE TOOLS section on the journal site.) No additional studies were identified through hand searches of these studies.…”

“…A majority of studies also received a weak rating on blinding (n = 7, 58%); 24,[27][28][29][33][34][35] this was mostly due to study design (e.g., pre-post) and the nature of the interventions, resulting in awareness among both assessors and participants of intervention status. A similar number of studies received a weak rating on data collection methods (n = 7, 58%) 24,26,[28][29][30]34,35 because most authors did not use validated tools or did not report their psychometric properties. Finally, five (42%) of the studies received a weak rating for withdrawals and dropouts because of high attrition (52%-77%) or unreported follow-up rates.…”

“…35 In total, four studies (33%) had sample sizes greater than 500 subjects. 28,30,34,35 Only four studies (33%) provided participation rates, which ranged from 32% to 77%. 24,25,27,32 Four studies (33%) recruited specific groups of individuals, including female college students 27,32,33 and African American women.…”

“…A majority of studies (n = 8, 67%) were conducted in the United States, 25,27-33 three in Australia, 26,34,35 and one in Italy. 24 Study designs included randomized controlled trials (n = 5, 42%), 25,28,31,32,34 quasiexperimental studies (n = 1, 8%), 30 pre-post studies (n = 5, 42%), 24,26,27,29,33 and interrupted time series (n = 1, 8%). 35 In total, four studies (33%) had sample sizes greater than 500 subjects.…”

“…The selection bias component of the EPHHP had the highest number of weak ratings (n = 8, 67%) 24,25,27,[29][30][31][32][33] due to low (32%-77%) or unreported participation rates, as well as study participants' poor representativeness of the broader target population because of selfreferral into the study. A majority of studies also received a weak rating on blinding (n = 7, 58%); 24,[27][28][29][33][34][35] this was mostly due to study design (e.g., pre-post) and the nature of the interventions, resulting in awareness among both assessors and participants of intervention status. A similar number of studies received a weak rating on data collection methods (n = 7, 58%) 24,26,[28][29][30]34,35 because most authors did not use validated tools or did not report their psychometric properties.…”