Early Preconception Education and Intervention for Women at High Risk of Preterm Birth

Despite our efforts, women in the United States continue to experience high risk pregnancies. Preterm births have risen 20% since 1990. Although preterm birth is multifactorial, one clearly identified risk is prior preterm birth. As many as 50% of pregnancies are unplanned. By identifying maternal risk factors prior to pregnancy we can hope to improve pregnancy outcomes. Preconceptional health care refers to a women addressing her overall health and planning her pregnancy for optimal outcome. Preconception health includes modifying risk factors such as smoking, obesity, diabetes, and hypertension.
Our program provides enhanced preconception health care for women at risk for subsequent preterm delivery. Through a grant from the Delaware Chapter of the March of Dimes and under the auspices of the Delaware Healthy Mothers and Infant Consortium, this first of its’ kind program was started at a regional level three NICU. Women who deliver an infant (s) <37 weeks gestation are identified. A letter is given to these mothers describing the program. Women who are non-English speaking or who have chosen permanent sterilization are not eligible.
An advanced practice nurse speaks with the mothers in the NICU, and those who chose to participate are given a health screen/risk assessment. Women are encouraged to see this as a time to care for themselves. Included in this assessment is a review of the current preterm pregnancy. The interview ends with an open ended question whereby the mother can ask for information regarding any personal health concern.
After the interview the APN compiles a folder with information regarding identified risks. Topics include diet and exercise, medications, environment, and health history. Information is in the form of articles, handouts, graphs, pictures, internet web sites, and phone numbers for interventional services such as smoking cessation or community resources. All resources are geared to the mothers’ educational level as determined during the interview. 
Follow up is arranged to explain the recommendations. The mother is given her information as well as the name and phone number of the advanced practice nurse for any later questions.  Education about risk factors and the importance of follow up is stressed. Mothers are encouraged to keep their postpartum appointment. In addition letters are sent to the obstetric care giver outlining identified risk factors and suggested interventions. At six and twelve months the mothers are contacted by phone to discuss questions and assess health and pregnancy status.
At the initial start up for the project a resource file was compiled. Our goal for the next year is to include preconception health care as a part of the routine discharge teaching in the NICU. The protocol can be shared with other hospitals throughout our network. Many more women can be targeted, and preconception health care will reach a larger number of childbearing women. This can only serve to improve the health of women in our state.