Associations Between Modifiable Preconception Care Indicators and Pregnancy Outcomes.

Abstract

Purpose: This study explored gaps and opportunities in preconception care with a focus on determining whether modifiable preconception care indicators are associated with preterm births.

Methods: This retrospective case-control study explored prepregnancy data of patients ≥18 years old who delivered preterm (cases) versus full term (controls) between June 1, 2018, and May 31, 2019, at a health care network in Pennsylvania. Cases were matched 1:2 with controls based on age, parity, and history of preterm delivery. A literature review yielded 11 key indicators of quality preconception care. Documentation of counseling on these indicators were extracted from patient charts from their most recent primary care visit before pregnancy (preconception care) and their pregnancy intake visit (prenatal care). Bivariate analyses were used to assess whether any of the 11 preconception indicators were associated with preterm birth. All analyses were conducted using SPSS statistical software.

Results: Our sample included 663 patient charts: 221 preterm births and 442 term births. Elevated blood pressure (>120/80) in the preconception period (Odds Ratio [OR] = 1.84) and at the prenatal intake visit (OR = 1.68) was significantly associated with preterm birth. In addition, patients with Body Mass Index (BMI) ≤18 or ≥30 at their prenatal visit were nearly twice as likely (OR = 1.85) to have pregnancies resulting in preterm birth.

Conclusions: Our study highlights BMI and Blood Pressure (BP) as key focus points for preconception counseling. Additional studies are needed to determine whether pregnancy outcomes other than preterm birth may be influenced by these and other preconception care indicators.