Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
U.S. Public Health Service Commissioned Corps.
MMWR Surveill Summ. 2018 Jan 19;67(1):1-16. doi: 10.15585/mmwr.ss6701a1.
PROBLEM/CONDITION: Preconception health is a broad term that encompasses the overall health of nonpregnant women during their reproductive years (defined here as aged 18-44 years). Improvement of both birth outcomes and the woman's health occurs when preconception health is optimized. Improving preconception health before and between pregnancies is critical for reducing maternal and infant mortality and pregnancy-related complications. The National Preconception Health and Health Care Initiative's Surveillance and Research work group suggests ten prioritized indicators that states can use to monitor programs or activities for improving the preconception health status of women of reproductive age. This report includes overall and stratified estimates for nine of these preconception health indicators.
2013-2015.
Survey data from two surveillance systems are included in this report. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing state-based, landline and cellular telephone survey of noninstitutionalized adults in the United States aged ≥18 years that is conducted by state and territorial health departments. BRFSS is the main source of self-reported data for states on health risk behaviors, chronic health conditions, and preventive health services primarily related to chronic disease in the United States. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing U.S. state- and population-based surveillance system administered collaboratively by CDC and state health departments. PRAMS is designed to monitor selected maternal behaviors, conditions, and experiences that occur before, during, and shortly after pregnancy that are self-reported by women who recently delivered a live-born infant. This report summarizes BRFSS and PRAMS data on nine of 10 prioritized preconception health indicators (i.e., depression, diabetes, hypertension, current cigarette smoking, normal weight, recommended physical activity, recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method) for which the most recent data are available. BRFSS data from all 50 states and the District of Columbia were used for six preconception health indicators: depression, diabetes (excluded if occurring only during pregnancy or if limited to borderline/prediabetes conditions), hypertension (excluded if occurring only during pregnancy or if limited to borderline/prehypertension conditions), current cigarette smoking, normal weight, and recommended physical activity. PRAMS data from 30 states, the District of Columbia, and New York City were used for three preconception health indicators: recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method by women or their husbands or partners (i.e., male or female sterilization, hormonal implant, intrauterine device, injectable contraceptive, oral contraceptive, hormonal patch, or vaginal ring). Heavy alcohol use during the 3 months before pregnancy also was included in the prioritized set of 10 indicators, but PRAMS data for each reporting area are not available until 2016 for that indicator. Therefore, estimates for heavy alcohol use are not included in this report. All BRFSS preconception health estimates are based on 2014-2015 data except two (hypertension and recommended physical activity are based on 2013 and 2015 data). All PRAMS preconception health estimates rely on 2013-2014 data. Prevalence estimates of indicators are reported for women aged 18-44 years overall, by age group, race-ethnicity, health insurance status, and reporting area. Chi-square tests were conducted to assess differences in indicators by age group, race/ethnicity, and insurance status.
During 2013-2015, prevalence estimates of indicators representing risk factors were generally highest and prevalence estimates of health-promoting indicators were generally lowest among older women (35-44 years), non-Hispanic black women, uninsured women, and those residing in southern states. For example, prevalence of ever having been told by a health care provider that they had a depressive disorder was highest among women aged 35-44 years (23.1%) and lowest among women aged 18-24 years (19.2%). Prevalence of postpartum use of a most or moderately effective method of contraception was lowest among women aged 35-44 years (50.6%) and highest among younger women aged 18-24 years (64.9%). Self-reported prepregnancy multivitamin use and getting recommended levels of physical activity were lowest among non-Hispanic black women (21.6% and 42.8%, respectively) and highest among non-Hispanic white women (37.8% and 53.8%, respectively). Recent unwanted pregnancy was lowest among non-Hispanic white women and highest among non-Hispanic black women (5.0% and 11.6%, respectively). All but three indicators (diabetes, hypertension, and use of a most or moderately effective contraceptive method) varied by insurance status; for instance, prevalence of current cigarette smoking was higher among uninsured women (21.0%) compared with insured women (16.1%), and prevalence of normal weight was lower among women who were uninsured (38.6%), compared with women who were insured (46.1%). By reporting area, the range of women reporting ever having been told by a health care provider that they had diabetes was 5.0% (Alabama) to 1.9% (Utah), and women reporting ever having been told by a health care provider that they had hypertension ranged from 19.2% (Mississippi) to 7.0% (Minnesota).
Preconception health risk factors and health-promoting indicators varied by age group, race/ethnicity, insurance status, and reporting area. These disparities highlight subpopulations that might benefit most from interventions that improve preconception health.
Eliminating disparities in preconception health can potentially reduce disparities in two of the leading causes of death in early and middle adulthood (i.e., heart disease and diabetes). Public health officials can use this information to provide a baseline against which to evaluate state efforts to improve preconception health.
问题/状况： 孕前健康是一个广义的术语，涵盖了育龄期（定义为 18-44 岁）非孕妇的整体健康状况。通过优化孕前健康，可以改善母婴的健康状况。优化备孕前和备孕期间的孕前健康对于降低母婴死亡率和妊娠相关并发症至关重要。国家孕前健康和保健倡议的监测和研究工作组建议了 10 项优先指标，各州可以使用这些指标来监测改善育龄妇女孕前健康状况的项目或活动。本报告包括这 9 项孕前健康指标的总体和分层估计值。
2013-2015 年。
本报告纳入了两个监测系统的数据。行为风险因素监测系统（BRFSS）是一个基于州的、基于电话的非机构化成年人调查系统，覆盖美国≥18 岁的成年人，由州和地区卫生部门进行。BRFSS 是各州报告有关美国慢性病主要相关健康风险行为、慢性病和预防保健服务的自我报告数据的主要来源。妊娠风险评估监测系统（PRAMS）是一个基于州和人群的美国监测系统，由疾病预防控制中心和州卫生部门合作管理。PRAMS 旨在监测妊娠前后妇女的某些产妇行为、状况和经历，这些经历是由最近分娩活产婴儿的妇女自我报告的。本报告总结了 BRFSS 和 PRAMS 数据，这些数据涉及 10 项优先孕前健康指标中的 9 项（抑郁、糖尿病、高血压、当前吸烟、正常体重、推荐的体力活动、近期意外怀孕、孕前服用多种维生素、产后使用最有效或中度有效的避孕方法），这些数据是最新的。BRFSS 数据来自 50 个州和哥伦比亚特区，用于 6 项孕前健康指标：抑郁、糖尿病（如果仅发生在妊娠期间或限于边缘/糖尿病前期情况，则排除）、高血压（如果仅发生在妊娠期间或限于边缘/高血压前期情况，则排除）、当前吸烟、正常体重和推荐的体力活动。PRAMS 数据来自 30 个州、哥伦比亚特区和纽约市，用于 3 项孕前健康指标：近期意外怀孕、孕前服用多种维生素以及女性或其丈夫或伴侣（即男性或女性绝育、激素植入物、宫内节育器、注射避孕药、口服避孕药、激素贴剂或阴道环）产后使用最有效或中度有效的避孕方法。在妊娠前 3 个月重度饮酒也被列入 10 项优先指标，但直到 2016 年，每个报告地区的 PRAMS 数据才可用。因此，本报告中不包括重度饮酒的估计值。所有 BRFSS 孕前健康估计值均基于 2014-2015 年的数据，除了两项（高血压和推荐的体力活动基于 2013 年和 2015 年的数据）。所有 PRAMS 孕前健康估计值均依赖于 2013-2014 年的数据。按年龄组、种族-民族、健康保险状况和报告地区报告了指标的流行率估计值。进行了卡方检验，以评估年龄组、种族/民族和保险状况对指标的差异。
在 2013-2015 年期间，风险因素指标的流行率估计值在年龄较大的妇女（35-44 岁）、非西班牙裔黑人妇女、无保险妇女和居住在南部各州的妇女中普遍较高，而健康促进指标的流行率估计值普遍较低。例如，曾被医疗保健提供者告知患有抑郁症的比例在 35-44 岁的妇女中最高（23.1%），在 18-24 岁的妇女中最低（19.2%）。产后使用最有效或中度有效的避孕方法的比例在 35-44 岁的妇女中最低（50.6%），在 18-24 岁的年轻妇女中最高（64.9%）。自我报告的孕前服用多种维生素和达到推荐的体力活动水平在非西班牙裔黑人妇女中最低（分别为 21.6%和 42.8%），在非西班牙裔白人妇女中最高（分别为 37.8%和 53.8%）。最近意外怀孕的比例在非西班牙裔白人妇女中最低，在非西班牙裔黑人妇女中最高（分别为 5.0%和 11.6%）。除了糖尿病、高血压和使用最有效或中度有效的避孕方法这三个指标外，所有指标（糖尿病、高血压和使用最有效或中度有效的避孕方法）都因保险状况而异；例如，当前吸烟的比例在未参保妇女中（21.0%）高于参保妇女（16.1%），未参保妇女正常体重的比例（38.6%）低于参保妇女（46.1%）。按报告地区，报告曾被医疗保健提供者告知患有糖尿病的妇女比例范围为 5.0%（亚拉巴马州）至 1.9%（犹他州），报告曾被医疗保健提供者告知患有高血压的妇女比例范围为 19.2%（密西西比州）至 7.0%（明尼苏达州）。
孕前健康风险因素和健康促进指标因年龄组、种族/民族、保险状况和报告地区而异。这些差异突出了可能受益于改善孕前健康的特定人群。
消除孕前健康方面的差异有可能减少导致中青年人早逝的两个主要原因（即心脏病和糖尿病）的差异。公共卫生官员可以利用这些信息来评估改善孕前健康的州级努力的基线情况。
