1. Freda, Margaret Comerford EdD, RN, CHES, FAAN, EDITOR

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During 2006, I was privileged to be on the Select Panel on Preconception Health, a project of the Centers for Disease Control and Prevention (CDC) that was supported by the March of Dimes. It was an incredible experience to see how a huge agency such as the CDC studies health issues and makes decisions about policy. I'm happy to tell you that of the 50 members of the Select Panel, many were nurses, and our voices were heard!! Other members were from all areas of healthcare, including physicians, public health agencies, community health activists, midwives, third-party payers, and government agencies. We put together a wonderful conference on preconception health and then debated within the Select Panel on how to help shape policy and recommendations for the public and for professionals about preconception health. On April 21, 2006, our recommendations were published in the Morbidity and Mortality Weekly Report, a document faithfully read by public health advocates and activists all over the world. Our goals were to improve knowledge about preconception health, to assure that all women could be eligible for preconception health services, to reduce risks from prior poor outcomes, and to reduce disparities in pregnancy outcomes. Here's a shortened version of our recommendations:


1. All women and men should have a reproductive plan (this doesn't mean that all women should conceive, just that all women should consider their options and make active decisions about when and if they will become pregnant).


2. Teach consumers about the importance of preconception health.


3. Preventive visits. (Every visit to a healthcare provider can be a preconception visit if the provider considers the woman's future pregnancy before prescribing medications or giving health advice. For instance, the provider should think "How would this drug affect a developing fetus if this woman becomes pregnant unexpectedly?")


4. Interventions for identified risks. For instance, diabetes should be in control, as should blood pressure, if a conception is planned.


5. Interconception care. (Women who have had a poor outcome such as a stillbirth or a preterm birth should obtain specialized care between pregnancies, hoping to change their risk factors.)


6. Prepregnancy check-up. (Every woman planning a pregnancy should see a healthcare provider months before she plans to conceive in order to check immunization status and general health status.)


7. Health coverage for low-income women.


8. Public health programs should integrate preconception care.


9. Research. (Scientific study of the outcomes of women who had appropriate preconception health to determine its worth and cost effectiveness.)


10. Monitor improvements. (Programs offering preconception services should be monitored to evaluate outcomes.)



I believe that nurses are integral to the goals and to the recommendations. We are the teachers. We spend time with women and families, and we are the educators whom women trust. Nurses who work in labor and delivery, postpartum, mother-baby, antenatal care, public health, and research can all take part in this movement to help educate women. We know that getting into prenatal care early is not enough, that taking folic acid before conception can significantly reduce neural tube defects, and that immunizations such as rubella can only be given months before a pregnancy is conceived, not after.


Please take part in this movement!! You can go to the CDC Web site ( and type "preconception" in the search menu to get lots of more information. You can access the Morbidity and Mortality Weekly Report to read it completely. You can go the March of Dimes Web site ( to learn all about preconception health as well. We can make a difference, let's do it!!


Margaret Comerford Freda, EdD, RN, CHES, FAAN, EDITOR