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Patient is (PIC)turing Pregnancy - Family Planning and Contraception

Background

Scope: Both unintended pregnancies and short and long term interpregnancy intervals are associated with poorer health outcomes.

    • Unintended Pregnancies: About 50 percent of all pregnancies are unplanned in the U.S. The proportion of this being teens younger than 15 at 98 percent. Women more likely to have unintended pregnancy are unmarried women, black women, and women with low education or income. About 50 percent of the unintended pregnancies reported in a month occurred even with contraception most likely because of inconsistent/improper use, side effects, partner sabotage, etc. Healthy People 2020 goal is to reach 56 percent of intended pregnancy.

      • Poorer health outcomes are associated with unintended pregnancies including: increased likelihood of abortion, late prenatal care, maternal depression, exposures to harmful substances in pregnancy, reduced school completion and lower income.
  • Short and Long Term Pregnancy Intervals: Short intervals (less than 18 months) are more common in women older than 35 years of age, non-Hispanic black mothers, and lower education levels. Nearly 29 percent of U.S. mothers in 2014 (30+% in Ohio in 2011) had a short interval pregnancy.

      • Interpregnancy levels are significantly associated with pregnancy risks such as low birth weight, preterm births, and early neonatal deaths.

      • A meta-analysis of 67 articles a (Conde-Agudelo et al., JAMA 2006) and the National Vital Statistics Reports (Copen et. al., 2015) confirmed that intervals < 18 months and         >59 were associated with the pregnancy risks. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_03.pdf

    • Preconception Significance:

    • Being the healthiest state possible before conception is necessary to bring in healthy new babies. This becomes difficult when women do not actively think about when they would like to become pregnant. Because nearly 50 percent of pregnancies in the U.S. are unplanned, women risk the early development of their baby with unhealthy behaviors during the early stages of pregnancy.

      The reproductive life plan is a significant tool in determining who desires pregnancy, who is unsure/at risk, and who does not desire pregnancy.

  • Risk Identification Strategies:

Clinician Guide

  • Healthcare providers should screen for substance use and STD/STIs for every woman desiring pregnancy.

  • Healthcare providers should counsel on risky behaviors and the reproductive life plan for every woman desiring pregnancy.

    • Based on when she plans to conceive, provide counseling and appropriate contraception.

    • For women with medical conditions, healthcare providers should refer to the US Medical Eligibility Criteria for appropriate contraceptive method according to condition and safety.

      http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usmec.htm

      https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=595752188&mt=8 (iPhone App)

    • For women who reveal medical conditions as preconception risk factors, health providers should encourage delay of conception until baseline health levels are achieved and consultations are completed.

    • Health providers should advise (if appropriate) an 18-59-month interval interpregnancy interval. However, this decision can only be guided by the professional, as the decision is very individual/couple based. Whatever is decided, health providers must work to ensure the healthiest pregnancy possible.

     

*All information obtained by CDC and https://beforeandbeyond.org

Page Updated: 8/9/2017