Despite major advances in medical care, poor birth outcomes continue to be a problem in the United States. Each year, 12% of babies are born premature, 8% are born with low birth weight, and 3% have major birth defects. Of women giving birth, 31% suffer pregnancy complications. Risks associated with poor pregnancy outcomes remain prevalent among women of reproductive age. For example, 11% of women smoke during pregnancy, and 10% consume alcohol. Of women who could get pregnant, 69% do not take folic acid supplements, 31% are obese, and about 3% take prescription or over the counter drugs that are known teratogens. In addition, about 4% of women have preexisting medical conditions, such as diabetes, that can negatively affect pregnancy if unmanaged. All of these factors pose risk to pregnancies, but could be addressed with proper health interventions.
Prenatal care, which usually begins at week 11 or 12 of a pregnancy, comes too late to prevent a number of serious maternal and child health problems in the U.S. The fetus is most susceptible to developing certain problems in the first 4-10 weeks after conception, before prenatal care is normally initiated. Because many women are not aware that they are pregnant until after this critical period of time, they are unable to reduce the risks to their own and to their baby's health unless intervention begins before conception.
Preconception care is critical to improving the health of the nation. The Healthy People 2000 goals set a target aiming for 60% of primary care physicians to provide age-appropriate preconception care, yet only about one in four providers currently provides preconception care to the majority of the women they serve. Preconception care could succeed in improving maternal and child health where the current paradigm is failing, but most providers don't provide it, most insurers don't pay for it, and most consumers don't ask for it.
