Supplement
The clinical content of preconception care: an overview and preparation of this supplement

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In June 2005, the Select Panel on Preconception Care established implementation workgroups in 5 areas (clinical, public health, consumer, policy and finance, and research and surveillance) to develop strategies for the implementation of the Centers for Disease Control and Prevention recommendations on preconception health and healthcare. In June 2006, members of the clinical workgroup asked the following questions: what are the clinical components of preconception care? What is the evidence for inclusion of each component in clinical activities? What health promotion package should be delivered as part of preconception care? Over the next 2 years, the 29 members of the clinical workgroup and > 30 expert consultants reviewed in depth > 80 topics that make up the content of the articles that are contained in this supplement. Topics were selected on the basis of the effect of preconception care on the health of the mother and/or infant, prevalence, and detectability. For each topic, the workgroup assigned a score for the strength of the evidence that supported its inclusion in preconception care and assigned a strength of the recommendation. This article summarizes the methods that were used to select and review each topic and provides a summary table of the recommendations.

Section snippets

Selection of topics to be reviewed

The workgroup identified a set of specific criteria to assist in choosing among the clinical topics to be reviewed. The resulting selection criteria comprised the following items: (1) There is a good chance that the health of the mother or the infant will be improved if the condition is identified and addressed before pregnancy; (2) the burden of suffering and prevalence of the condition are sufficient to justify screening and treatment; (3) the condition is detectable in clinical care in

Health promotion and risk reduction

The clinical workgroup retained the organizational structure that was promulgated by the Expert Panel on the Content of Prenatal Care,3 which suggested that the components of preconception care include the provision of health education that is individualized to a woman's or couple's needs (health promotion), a thorough and systematic identification of risks (risk assessment), and the initiation of actions to address those risks (interventions) with women and men of reproductive age to reduce

Presentation of each topic and recommendations for clinical care

The information that is provided about each topic was standardized based on the format that was developed by the United States Preventive Services Task Force.5 Each topic is reviewed with the following structure: (1) The burden of suffering, which includes the prevalence and importance of the target condition; (2) the accuracy of the screening methods that are available to detect the condition either in primary or specialty settings; (3) the effectiveness and availability of current treatments

Strength of recommendations and quality of the evidence

The strength of the recommendation and the quality of the evidence for each of the clinical components were then rated by the authors and editors, and consensus was reached. The criteria that were used were adapted from those criteria that were used in the report of the US Preventive Services Task Force Guide of Clinical Preventive Services.5 The following criteria were used to determine the quality of the evidence and the strength of the recommendation:

Summary of preconception recommendations

The Table provides a summary list of the topics that were reviewed, the consensus recommendation for each topic, the strength of the recommendation, and the rating of the quality of the evidence. Together, we believe that these recommendations represent the current state of the art in defining the evidence-based best practices in preconception care. These recommendations also identify the areas of preconception care in which more research is needed. We expect these recommendations to change as

References (5)

  • H. Atrash et al.

    Where is the “W” in MCH?

    Am J Obstet Gynecol

    (2008)
  • Recommendations for improving preconception health and health care: United States: a report of the CC/ATSDR Preconception Care Workgroup and the Select Panel on Preconception Care

    MMWR Morb Mortal Weekly Rep

    (2006)
There are more references available in the full text version of this article.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflict of Interest: Brian W. Jack, MD; Hani Atrash, MD, MPH; Merry-K Moos, BSN, FNP, MPH; Julie O'Donnell, MPH; and Kay Johnson, MPH, EdM have no conflict of interest including grants, honoraria, advisory board membership, or share holdings. Dean V. Coonrod, MD, MPH, is a Grant Recipient from the March of Dimes Arizona Chapter to develop an internatal Care Clinic and has funding from CMS (#1HOCMS030207 101) working on compliance with the 6 week postpartum visit as a strategy to improve preconception care.

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