Variations In Women’s Knowledge And Attitudes Regarding

Preconception Healthcare

Peter S. Bernstein, MD, MPH

Professor of Clinical Obstetrics & Gynecology and Women’s Health

Introduction• Women vary in their knowledge of the importance of

Preconception Care

• Frey and Files surveyed 499 women attending an Internal Medicine/Family Medicine private practice in AZ.– 98% recognized the importance of improving health prior to

conception

– Responses to knowledge questions were correct 54-99% of the time

– 39% recalled their MD speaking about Preconception Health issues

Matern Child Health J, 2007

Introduction

• A second study of mostly Mexican-American women (n = 305) of lower socioeconomic status found:– Lower levels of correct responses to knowledge

questions (range 30-94%)

– But 95% knew it was important to improve health prior to conception

– 41% reported that an MD had spoken to them about the importance of preconception health

Coonrod et al., Am J Obstet Gynecol 2009

Knowledge that folic acid should be taken before pregnancy

US, 1995-2008

Nationally representative telephone surveys conducted by Gallup, targeting approximately 2000 English-speaking women ages 18-45 each year. Margin of error is +/- 3%. Survey not conducted in 1996 and 1999. Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved June 2, 2011, from www.marchofdimes.com/peristats.

Daily use of folic acid among women 18-45 years

US, 1995-2008

Nationally representative telephone surveys conducted by Gallup, targeting approximately 2000 English-speaking women ages 18-45 each year. Margin of error is +/- 3%. Survey not conducted in 1996 and 1999. Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved June 2, 2011, from www.marchofdimes.com/peristats.

Knowledge that folic acid prevents birth defects

US, 1995-2008

Nationally representative telephone surveys conducted by Gallup, targeting approximately 2000 English-speaking women ages 18-45 each year. Margin of error is +/- 3%. Survey not conducted in 1996 and 1999. Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved June 2, 2011, from www.marchofdimes.com/peristats.

Objective• To survey and compare non-pregnant

reproductive age women seeking care at two different OBGYN practices that serve differing populations:– Larchmont Women’s Center primarily serves

women with private commercial insurance (PCI)– Comprehensive Family Care Center, a Federally-

qualified Community Health Center (CHC) that primarily serves women on public assistance.

Methods• Self-administered survey of knowledge

and attitudes regarding preconception care developed by Frey and colleagues (Matern Child Health J, 2007)– Utilized 5 point Likert scale and multiple

choice questions– Available in English and Spanish– Completed while waiting for visit– Classified as “Exempt” by the IRB

Methods• Primary outcome variable: Awareness of

the need for preconception care

• Sample size calculation:– Assuming the PCI group had a similar belief in

the need for preconception care (98%)– 100 patients needed in each group to detect a

5% difference in response by the CHC group

Results: DemographicsCHC (n=105)

PCI(n=108)

p-value

Age (years)* 30.0 (7.6) 30.8 (7.8) 0.003

Race**BlackHispanicAsianCaucasianOther

 35 (34%)41 (40%)4 (3.9%)3 (2.9%)19 (3.7%)

 19 (18.3%)10 (9.6%) 4 (3.8%)62 (59%)9 (19%)

<0.001 

Cohabiting with partner**

49 (48%) 59 (55%) 0.273

*mean (SD)**n (percent)

Results: DemographicsCHC (n=105)

PCI(n=108)

p-value

Education<12th gradeHigh school graduateSome college/technical schoolCollege graduate Some graduate educationGraduate degree

 14 (14%)22 (22%)37 (37%)21 (21%)4 (4%)3 (3%)

2 (2%)6 (5.6%)29 (27%)35 (33%)9 (8.4%)26 (24%)

<0.001 

Annual Income < $25,000 $26-50,000 $51-75,000$76-99,000 > $100,000

 48 (52%)35 (38%)7 (7.6%)2 (2.2%)0

 12 (12%)25 (25%)21 (21%)10 (9.8%)34 (33.6%)

<0.001 

Note: n (percent)

Results: Reproductive Characteristics

Characteristic CHC n (percent) 

PCIn (percent)

p-value

Pregnancy Plans No Plans Trying, hope to be pregnant Hope to be pregnant in 1-2 years Hope to be pregnant in 3-5 years Not able to get pregnant

 63 (62%)13 (13%)6 (5.9%)15 (15%)5 (4.9%)

 72 (67%)3 (2.8%)14 (13.1%)16 (15%)2 (1.9%)

0.024

Ever pregnant 84 (80%) 57 (53%) <0.001

If ever pregnant, prior unplanned pregnancy a

59 (70%) 34 (58%) 0.119

Currently using contraception b 47 (51%) 67 (64%) 0.059

a. Respondents: CHC=84; PCI=59b. Respondents: CHC=93; PCI=105

Results: Preconception Health Info.Item CHC

n (percent)PCIn (percent)

p-value

Has a doctor spoken to you about “preconception health”?

61 (59%) 45 (43%) 0.015

Interested in receiving preconception health education. (Very interested/ Somewhat interested)

67 (65%) 63 (59%) 0.329

When would you prefer to receive preconception health education? **

1. At the time I become pregnant 2. Before I try to get pregnant 3. During pregnancy and until delivery 4. Every time I get an annual exam 5. Unsure

  10 (11%)40 (42%)5 (5.3%)22 (23%)18 (19%)

   4 (4.0%)5 (59%)2 (2.0%)21 (21%)14 (14%)

0.095

**Respondents: CHC=95; PCI=100

Results: Selected Knowledge QuestionsQuestions CHC

n (%)PCIn (%)

p-value

Review of medications prior to pregnancy 93 (89%) 103 (97%)

0.024

Talk to doctor about diseases in the family prior to getting pregnant

92 (86%) 84 (79%) 0.052

Important to be tested for infectious diseases before getting pregnant

91 (89%) 104 (97%)

0.021

Important to be tested for infectious diseases before getting pregnant

91 (89%) 104 (97%)

0.021

Regular exercise can harm an unborn child 69 (68%) 88 (82%) 0.015

A woman thinking about getting pregnant should avoid some fish products

57 (59%) 76 (73%) 0.041

Results: Selected Patient Attitude Items

Item CHC n (%)

PCIn (%)

p-value

A woman should improve her health if considering getting pregnant

91 (89%) 106 (99%)

0.002

A woman has control over her health 74 (72%) 95 (88%) 0.002

A woman needs help of health professionals to improve her health

77 (77%) 68 (68%) 0.044

Discussion

• Interest in preconception health was high in both groups (approx. 60%)

• Responses to knowledge tended to be >80% correct though gaps existed

• Women of lower socioeconomic status tended to do less well on knowledge questions

Discussion• Providers at CHC were more likely to have

raised preconception health as a topic (though low at both sites)

• Need apparently greater at CHC site– Knowledge deficit greater– Women at CHC felt less in control of their

health– More women at CHC site felt that the help of a

health provider was needed to improve health

Thanks to my co-authors:

• Shilpi Mehta, MD

• Yves-Richard Dole, MD

• Lisa Simmonds, MD

• Ashlesha Dayal, MD

• Setul Pardanani, MD