Preventing Low Birthweight (1985) / Chapter Skim
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5. Planning for Pregnancy
5. Planning for Pregnancy
Pages 119-131
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From page 119... ...
Only casual attention has been given to the proposition that one of the best protections available against low birthweight and other poor pregnancy outcomes is to have a woman actively plan for pregnancy, enter pregnancy in good health with as few r isk factors as possible, and be fully informed about her reproductive and general health. This chapter covers three courses of action applicable before conception to reduce the incidence of low birthweight: 1.
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From page 120... ...
And finally, the risk factors of childbearing at extremes of the reproductive age span, brief interpregnancy interval, and high par ity can be managed by family planning to prevent, or more carefully time, the occurrence of pregnancy. Such considerations have led some experts to suggest that more attention be given to preconception counseling aimed at detecting risk factors and intervening, where possible, to reduce them.3 4 Anecdotal and small area reports indicate that informal prepregnancy consultation already occurs in some settings and is used as an opportunity to gather relevant information including historical, physical, and laboratory data; to discuss potential risks before conception occurs; and to refer for specific services ranging from treatment of medical problems to behavioral risk reduction programs, such as smoking cessation activities.
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From page 121... ...
_ The committee concludes that identifying and reducing r isks before pregnancy can help reduce the incidence of low birthweight. Realizing the benefits of this strategy will require: · further elaboration and discussion by the relevant profess tonal groups of the content and timing of such counseling, with particular attention to data on the r isks associated with low birthweight (and other poor pregnancy outcomes)
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From page 122... ...
Enlarging the Content of Health Education A second strategy in the period before pregnancy is concerned with health education related to reproduction. Education about reproduction, contraception, pregnancy, and associated topics is already provided in a variety of ways: through public information campaigns; in schoolbased classes, group sessions, lectures, and related printed materials; and in various health care settings.
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From page 123... ...
the general concept of reducing specific risks before conception and the advisability of consultation before pregnancy to identify and reduce risks associated with low birthweight; 3. the importance of early pregnancy diagnosis and of early, regular prenatal care, and where to obtain such services; 4.
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From page 124... ...
To be more helpful in this regard, the content of such education should be expanded to include discussion of the ma jor r isk factors associated with low birthweight and the importance of early pregnancy diagnosis and prenatal care. Health education should be provided in a variety of settings, particularly in family planning clinics and schools, and be strengthened in the private sector as well.
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From page 125... ...
For example, family planning services, as well as abortion and sterilization, have decreased childbearing among women with high-risk characteristics such as grand multiparity, chronic severe hypertension, and appreciable heart and renal disease, as well as such demographic risks as age (under 17 and over 34~. Better documentation exists to show that family planning has been especially useful to two populations at increased risk of low birthweight, low-income women and teenagers.
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From page 126... ...
In sum, although the exact mechanisms and magnitude of effect are not well defined, there does seem to be general agreement that family planning has had a positive impact on infant mortality and probably also on low birthweight. The committee concludes that family planning services should be an integral part of overall strategies to reduce the incidence of low birthweight in infants.
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From page 127... ...
.2 9 In this regard, the committee calls attention to the special role of Title X of the Public Health Service ACE, the Family Planning Assistance Program. Title X authorizes project grants to public and private nonprofit organizations for the provision of family planning services to all who need and want them, including sexually active adolescents, but with priority given to low-income persons.
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From page 128... ...
Emphasis in any family planning program should be given to the prevention of unwanted pregnancies in sexually active teenagers, particularly those under 18 who are unmarried. (As noted in Chapter 2, childbearing in early adolescence carries an increased risk of low birthweight, even though such risk appears to derive less from young age itself than from the other r isk factors that accompany teenage childbearing, such as poor educational attainment, low socioeconomic status, and late receipt of prenatal care.)
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From page 129... ...
In a fundamental sense, healthypregnancies begin before conception. The committee emphasizes, therefore, the importance of prepregnancy risk identif ication, counseling, and risk reduction; health education related to pregnancy outcome generally and to low birthweight In particular; and full availability of family planning services, especially for Cow income women and adolescents.
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From page 130... ...
_ — ~ 10:135-142, 17. Forrest JD, Hermalin AI, and Henshaw SK: The impact of family planning clinic programs on adolescent pregnancy.
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From page 131... ...
20. Kleinman JC, Machlin SR, Cooke MA, and Kessel SS: The relationship between delay in seeking prenatal care and the wantedness of the child.
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