CDC’s Preconception Health and Health Care Initiative: History and An Update

1. CDC’s Preconception Health and Health Care Initiative: • History and An Update Hani K. Atrash, MD, MPH hka1@cdc.govAssociate 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"

2. 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 workgroup • Pilot Urban Practice Collaborative

3. 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

4. If you continue to do what you always did, You will continue to get What You always got Anonymous

5. Paradigm Shift From Anticipation and Management to Health Promotion and Prevention From Healthy Mothers Healthy Babies to Healthy Women Healthy Mothers Healthy Babies

6. 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

7. 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

8. 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”

9. 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

10. The CDC PCC Initiative: Timeline 9/06 Supplement 6/05 1st Summit 10/07 2nd Summit 5/06 Clinical, PH, Consumer Workgroup Meetings 6/04 CDC Workgroup 5/07 2nd Select Panel Meeting 1/06 Steering Committee Meeting 6/05 Select Panel Meeting 4/06 Recommendations 11/04 Meeting with Partners 3/07 Policy & Finance Workgroup Meetings

11. www.marchofdimes.com/california

12. Partners 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

13. 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

14. 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

15. 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

16. Implementation: The Goals • Changing consumer knowledge, attitudes, and practices • Changing clinical providers’ knowledge, attitudes, and practices • Change public health professionals’ knowledge, attitudes, and practices

17. Strategies to Implement The Recommendations Workgroup Meetings: • June 27/28-2006: • Clinical • Public Health • Consumer • March 2007: • Policy and Finance

18. 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

19. Strategies for Implementation

20. Strategies for Implementation

21. Strategies for Implementation

22. Strategies for Implementation

23. 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

24. 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

25. 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

26. 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

27. 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

28. Team Hartford • Smaller racial/ethnically diverse urban area in the Northeast • Large Latina population • Project Focus: Integration of preconception health into existing MCH programs

29. Team Los Angeles • 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

30. Team Nashville • 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

31. Thank You! Questions??? hka1@cdc.gov www.cdc.gov/ncbddd