The negative pregnancy test. An opportunity for preconception care
B. W. Jack, C. Campanile, W. McQuade and M. D. Kogan
Department of Family Medicine, Brown University School of Medicine, Providence, RI, USA.
OBJECTIVE: To identify women who would likely benefit from preconception
care. METHODS: A comprehensive preconception risk survey was administered
during a structured interview to 136 women who had a negative pregnancy
test visit in a family practice residency ambulatory practice. The survey
solicited the presence of self-reported risk variables associated with
maternal conditions related to poor obstetric outcome, risk factors for
poor obstetric outcome, and risks for developing these conditions. RESULTS:
Seventy women (51.5%) reported a medical or reproductive risk that could
adversely affect pregnancy. In addition, 68 women (50%) reported a genetic
risk; 39 (28.7%) reported a risk for human immunodeficiency virus
infection, 35 (25.7%) reported an indication for hepatitis B vaccine, and
an equal number reported recent use of illegal substances; 23 (16.9%)
reported at least one affirmative answer to the CAGE questionnaire; 79
(58.5%) smoked cigarettes; 74 (54.4%) reported a nutrition risk; 126
(92.6%) reported a psychosocial risk; and 39 (28.7%) reported a perceived
barrier to ongoing medical care. Even with the psychosocial risk category
excluded, 94% of the women still reported at least one factor requiring
further evaluation, counseling, or intervention before pregnancy.
CONCLUSIONS: We discovered a significant number of women with obstetric
risk factors. A negative pregnancy test visit provides an opportunity for
preconception risk assessment and counseling. These results will guide us
to further develop practical preconception care protocols.
