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Hani K. Atrash, MD, MPH [email protected] Director for Program Development National Center on Birth Defects and Developmental Disabilities And,The CDC Select Panel on Preconception CareThe CDC/ATSDR Workgroup on Preconception Care, and

2007 CityMatCH Urban MCH Leadership Conference

August 26 - 28, 2007, Denver, Colorado

"The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry"

The preconception care team
The Preconception Care Team

  • Steering Committee:

    • CDC, HRSA/MCHB, ACOG, MOD, AMCHP, CityMatCH, Consultants

  • Select Panel:

    • Representatives of partner organizations, subject matter experts

  • CDC/ATSDR Workgroup:

    • Representatives of 22 programs (80+ members)

  • Workgroups (Clinical, Public Health, Consumer, Policy and Finance):

    • Practitioners, members of select

      panel, members of CDC/ATSDR


  • Pilot Urban Practice Collaborative

Why preconception care
Why Preconception Care

  • Poor Pregnancy Outcomes Continue To Be At Un-acceptable Levels

  • Women Enter Pregnancy “At Risk” For Adverse Outcomes

  • There Is Consensus That We Must Act Before Pregnancy

  • Intervening Before Pregnancy Will Help Improve Outcomes

  • We currently intervene too late

If you continue

to do what

you always did,

You will continue to get

What You always got


Paradigm Shift


Anticipation and Management


Health Promotion and Prevention


Healthy Mothers Healthy Babies


Healthy Women Healthy Mothers Healthy Babies

Not a new concept

Aristotle, Problemata, 384-322 BCE: Foolish, drunken, or harebrain women most often bring forth children like unto themselves

William Potts Dewees, first American textbook on Pediatrics 1825:“The physical treatment of children should begin as far as may be practicable, with the earliest formation of the embryo; it will, therefore, necessarily involve the conduct of the mother, even before her marriage, as well as during her pregnancy.”

Domestically, starting in 1979: Reference in government and professional reports

Internationally MCH and women’s health meeting reports starting in the 1960s

Not a New Concept

Why a CDC Preconception Health and Health Care Initiative?

  • Opportunities are missed

  • New strategies are needed

    • Facilitate collaboration

    • Develop recommendations

    • Identify and address obstacles and opportunities:

      • Clinical, Public health, Consumer, Policy & Finance, Research

Challenges to implementation 2004
Challenges to Implementation (2004)

  • Absence of a national policy

    that supports implementation

  • Lack of National/State/Local

    Model programs

  • Lack of tools and practical guidelines for practice (Who does it, who gets it, how much, what is it, why do it, how to do it, where to do it, when to do it, etc?)

  • Inadequate education of providers and consumers

  • Lack of demonstrated practicality, feasiblity and effectiveness of preconception “programs”

The cdc pcc initiative initial plan
The CDC PCC InitiativeInitial Plan

  • Make the scientific case; Solidify the scientific evidence

  • Make the business case

  • Develop consensus within and outside CDC

  • Develop recommendations and national policy

  • Develop guidelines and tools for implementation

  • Develop marketing strategies:

    • Implement recommendations

    • Enhance knowledge and skills of providers

    • Educate consumers

The cdc pcc initiative timeline
The CDC PCC Initiative: Timeline




1st Summit


2nd Summit


Clinical, PH, Consumer

Workgroup Meetings


CDC Workgroup


2nd Select Panel



Steering Committee



Select Panel





Meeting with Partners


Policy & Finance

Workgroup Meetings


With CDC’s Environmental Health, Birth Defects and Developmental Disabilities, Chronic Disease, Infectious Diseases, National Immunization Program, Health Marketing, Health Statistics, HIV, STD, and TB Prevention, Women’s Health, Genomics and Public Health

Recommendations 1 5
Recommendations 1-5

  • Recommendation 1. Individual responsibility across the life span

  • Recommendation 2. Consumer awareness

  • Recommendation 3. Preventive visits

  • Recommendation 4. Interventions for identified risks

  • Recommendation 5. Interconception care

Recommendations 6 10
Recommendations 6-10

  • Recommendation 6. Pre-pregnancy check ups

  • Recommendation 7. Health coverage for low-income women

  • Recommendation 8. Public health programs and strategies

  • Recommendation 9. Research

  • Recommendation 10. Monitoring improvements

Steering Committee Meeting

The Road Ahead

  • Define contents

  • Integrate existing guidelines

  • Disseminate information

  • Demonstrate effectiveness

  • Explore means for financing

  • Monitor practice

  • Study association between women’s

  • health and pregnancy outcomes

  • Conduct a cost study

Implementation the goals
Implementation: The Goals

  • Changing consumer knowledge, attitudes, and practices

  • Changing clinical providers’ knowledge, attitudes, and practices

  • Change public health professionals’ knowledge, attitudes, and practices

Strategies to implement the recommendations
Strategies to Implement The Recommendations

Workgroup Meetings:

  • June 27/28-2006:

    • Clinical

    • Public Health

    • Consumer

  • March 2007:

    • Policy and Finance

  • Clinical guidelines and tools

    Consumer information

    Public health programs and strategies

    Monitoring and surveillance

    Research agenda

    Public policy and finance

    Professional education/training

    8. Best practices

    Demonstration projects

    State and local initiatives

    Strategies for Implementation

    Clinical workgroup
    Clinical Workgroup

    • Developing a Curriculum for training clinical care providers

    • Developing a uniform set of guidelines

    • Developing a standard assessment tool

    • Delivering lectures at various meetings and conferences

    • Developing a clinical demonstration project and other research projects

    Public health workgroup
    Public Health Workgroup

    • Assessing existing screening tools

    • Promoting education for public health students and workers

    • Modifying existing surveys to include questions on preconception health and health care

    • Evaluating preconception/interconception care activities under Healthy Start

    • Implementing Public Health Practice Collaboratives in Los Angeles, Nashville and Hartford

    Consumer workgroup other
    Consumer Workgroup/Other

    • Consumer Workgroup:

      • Developing consumer messages with market research

      • Conducting participatory action research with women at risk

    • Other:

      • Speakers’ Bureau with over 30 volunteers available to speak about preconception care

      • CDC and March of Dimes updated their websites to include more information about preconception care

      • Members of the steering committee are supporting several states who started working on preconception care

    The CityMatCH Pilot Urban Practice Collaborative

    • Acts on CDC Recommendation 8:“Integrate components of preconception health into existing local public health and related programs, including emphasis on interconnection interventions for women with previous adverse outcomes”

      • Uses a “practice collaborative” model to promote adoption and integration of Preconception health recommendations among peers

      • Encourages more integrated preconception health practices and policies in public health programs in urban settings

    CityMatCH Pilot Urban Practice Collaborative: Team Composition

    • Led by the urban public health program (CityMatCH member is the health department)

    • 5-person teams with expertise in:

      • community assessment/engagement

      • prevention programming

      • clinical practice

      • policy development and

      • systems integration of reproductive/women’s health

    • Each team has representatives from local March of Dimes, State MCH Director, & local community organizations

    • Each team will select a project to address preconception health in their community

    Team hartford
    Team Hartford Composition

    • Smaller racial/ethnically diverse urban area in the Northeast

    • Large Latina population

    • Project Focus: Integration of preconception health into existing MCH programs

    Team los angeles
    Team Los Angeles Composition

    • Large urban center with 1 of 4 US births occurring in the county

    • Tremendous potential impact on maternal and infant health outcomes

    • Project Focus: Improve data and surveillance preconception health issues

    Team nashville
    Team Nashville Composition

    • Mid-size, traditional Southern urban area with large Black population

    • Project Focus: Target special populations to address preconception health concerns of childbearing age women including young women with sickle cell disease & trait

    Thank You! Composition

    Questions??? [email protected]