Inter-conception care provides a unique opportunity to address specific risk factors that may have contributed to previous poor pregnancy outcomes.
The American Congress of Obstetricians and Gynecologists, District IX and the March of Dimes recently identified 21 of the most common threats to a healthy pregnancy and delivery. These risk factors include:
- Alcohol use
- Chronic hypertension
- Domestic violence
- Gestational diabetes
- Gonorrhea and Chlamydia
- Hepatitis B and C
- Overweight and obesity
- Postpartum depression
- Prior premature birth
- Prior C-section
- Substance use
- Thyroid disorder
- Tobacco use
Women with previous preterm birth
The greatest risk factor in preterm birth is a history of preterm birth. Identifying these women early and administering 17-alphahydroxyprogesterone caproate (17P) in appropriate candidates can avert subsequent prematurity. 17P is reimbursable through Medicaid and is available through compounding pharmacies and as a commercial product, Makena®. Candidates for 17P must meet the following criteria:
- Singleton pregnancy
- Previous spontaneous preterm delivery (<37 weeks gestation) of a single baby
The North Carolina 17P initiative is a statewide quality improvement initiative aimed to increase the use of 17P. The website provides guidance about the use and indications of 17P. Please note the information about billing is specific to North Carolina.
Learn more about the appropriate administration of 17P, as well as how to identify candidates, with this PowerPoint slide show from the DSHS Grand Rounds Program by Dr. George Saade of the University of Texas Medical Branch at Galveston.
Proper birth spacing
Birth spacing is a critical component of healthy preparation for pregnancy. It’s recommended that pregnancies be spaced no closer than 18 months and no further apart than 60 months. Planned pregnancies result in better outcomes and start with appropriate choices in birth control.
Between pregnancies, chronic conditions such as diabetes, mental illness, obesity, hypertension and thyroid disorders should be addressed and managed. These conditions play a critical role in a healthy pregnancy and often the treatment options are limited by the pregnancy state. Supporting behavior change regarding these conditions is an important complement to medical interventions.
Women’s birth control options must grow and change with their changing life circumstances — the birth control that worked well for them as young adults may not be an appropriate choice between pregnancies. Patients must be active and informed participants when it comes to their care. To do this, clinicians need to present the issue to their patient and engage them in collaborative decision making.
The Texas Department of State Health Services has more information concerning inter-conception care and its connection to preventing birth defects. Read more here.
These Healthy Texas Babies exam room posters help keep your patients informed and spur discussion of important health topics, including inter-conception care.
The Every Woman California project has developed a wealth of materials to support the clinician who provides pre- and inter-conception care. The Clinical Protocols include preconception algorithms, six-week postpartum checklists and questionnaire and preconception guidelines.
The Life Planning Tool can help patients and providers collaboratively think about goal setting for the inter-conception period and can prompt discussions about areas of concern for patients.
The My Health Priorities Patient Worksheet can assist providers in focusing their discussions during the clinical encounter, as well as serve as a checklist to address patient concerns on an ongoing basis.
Our Men’s and Women’s Heath Tips card for Spanish-speaking audiences outlines simple tips for daily wellness.