1. Preconception Health - A Survey among Health Care Practitioners Presented at CityMatCH annual conference September 12, 2005 Steve Abelman, MBA

2. Acknowledgements Jennifer Williams, Eliazbeth Fasset - CDC Joann Petrini - March of Dimes Cheryl Stone - Cheryl Stone Marketing Margaret Watkins, Kathryn Lyon Daniel, Christine Pure, Joe Mullinare - CDC Karla Damus - March of Dimes

3. Objectives Knowledge of unintended pregnancies Practice regarding recommendations for healthy behavior prior to pregnancy Knowledge of aspects of folic acid - benefits, dosage, timing of consumption

4. Objectives WHO WHY WHEN HOW

5. Methodology Random Sample Telephone Surveys 2002 - 611 OB/GYNs and 250 FPs 2003 –200 CNMs –101 NPs –55 PAs –144 RNs

6. Perceived Percentage of Unintended Pregnancies

7. % Eligible Patients Seen for Preconception Care Mean % Seen for Preconceptional Visit Providers-2003: 22% MDs-2002: 20%

8. Association: Perceived % of Unintended Pregnancies and % of Patients Seen for Preconception Care The chart shows the mean % of patients seen for preconceptional care by segments of providers estimating the % of unintended pregnancies at about 25%, 50%, 75%, or “don’t know/not sure” – by type of provider.  % prenatal patients seen for preconceptional care -------------------- % Unintended Pregnancies in US --------------------

9. Optimal Time for Starting Folic Acid

10. Issues Addressed at Annual Well- Woman Exam

11. Issues “Always” or “Usually” Addressed at Annual Well-Woman Exam

12. Association:Frequency of Addressing Multivitamins in Well-Woman Visit and % Seen for Preconceptional Care  % prenatal patients seen for preconceptional care ---------- How Often Recommend Multivitamins in Well-Woman Visit ----------

13. When (How) Do Providers Recommend Multivitamins or Folic Acid?

14. Perceived Benefits of Folic Acid

15. Perceived Nutrient Requirements for Non-Pregnant Women of Childbearing Age

16. Reasons Providers Don’t Always Recommend Folic Acid or Multivitamins

17. Summary of Findings Good knowledge on timing and benefits of folic acid Incomplete knowledge on rate of unintended pregnancies and appropriate dosage of folic acid Low rate of prenatal patients seen preconceptionally Inconsistency in addressing preconception issues during a well-woman exam Lack of knowledge and lack of time in addressing preconception issues

18. Summary of Findings WHO - all women of childbearing age WHY - prevention of birth defects among other issues WHEN - all patient encounters HOW - Verbal and written communication

19. Lessons Learned Lack of knowledge and practice regarding some preconception issues on a timely basis Providers of health care to women of childbearing age need to be educated about the rate of unintended pregnancies Providers need to be encouraged to address preconception and prenatal planning issues during every patient encounter

20. Next Steps Focus groups among leadership and practitioners of selected professional organizations to identify reasons for the gap between knowledge and practice; identify how providers who do incorporate practice guidelines regarding folic acid and preconceptional care are able to do so; assess barriers to change; and brainstorm strategies or interventions that would lead to significant improvement in implementation of these guidelines within health care practices.