The Centers for Disease Control and Prevention has provided significant support and effort to develop a targeted set of indicators to better allow states to monitor the preconception health and wellness of their populations. The internal workgroup at the CDC (PRESURV) developed a systematic process to evaluate, prioritize, and select 10 indicators that state maternal and child health programs can use for preconception health surveillance. They began with a list of 45 core preconception health and preconception care indicators and identified 24 new potential indicators. After excluding indicators related to health care, those that were non-specific to preconception health, and those that were unavailable on the most recent versions of the core Pregnancy Risk Assessment Monitoring System (PRAMS) and Behavioral Risk Factor Surveillance System (BRFSS) questionnaires, 50 preconception health indicators remained.
Evaluation of the indicators included assessing prevalence, whether they relate to professional recommendations, Healthy People 2020 objectives, or the Centers for Disease Control and Prevention winnable battles, measurement simplicity, and data completeness. Based on the evaluation and maternal and child health stakeholders’ input, they assigned each indicator to one of three tiers (Tier 1 represented the highest priority), and indicators were iteratively reviewed until consensus was reached about a condensed set of 10 Tier 1 preconception health indicators.
The condensed set includes indicators that rely on data from the Pregnancy Risk Assessment Monitoring System (n=4) and the Behavioral Risk Factor Surveillance System (n=6), and the content encompasses alcohol consumption, depression, diabetes, folic acid intake, hypertension, normal weight, physical activity smoking, unwanted pregnancy, and use of contraception.
Next steps include soliciting ideas and strategies for states to use these indicators to elevate the needs of young adults in their state and leverage support. Ideally, preconception health indicators would be shared annually along with standard prenatal care and infant mortality data report cards.
Final indicators include the Percentage of women who…
- Didn’t want to be pregnant then or at anytime in the future (unwanted) (PRAMS)
- They or their husband or partner currently use a more effective contraceptive method to keep from getting pregnant (PRAMS)
- Currently smoke everyday or some days (BRFSS)
- Had 8 or more drinks in an average week during the three months prior to pregnancy (PRAMS)
- They are normal weight (BMI 18.5-24.9 kg/m2) (BRFSS)
- Took a multivitamin, prenatal vitamin, or a folic acid supplement everyday of the month prior to pregnancy (PRAMS)
- Meet the recommended levels of physical activity (BRFSS)
- Have ever been told that they have a depressive disorder (BRFSS)
- Have ever been told that they have diabetes (BRFSS)
- Have ever been told that they have hypertension (BRFSS)
A manuscript describing the process is under preparation.
To learn about the current state of preconception health: Core State Preconception Health Indicators – Pregnancy Risk Assessment Monitoring System and Behavioral Risk Factor Surveillance System, 2009, MMWR, April 25, 2014.