Seattle-Denver Center of Innovation for Veteran - Centered and Value-Drived Care, VA Puget Sound Health Care System, Seattle, Washington.
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington.
Semin Reprod Med. 2018 Nov;36(6):327-339. doi: 10.1055/s-0039-1678753. Epub 2019 Apr 19.
Preconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.
孕前保健（PCC）定义为一套干预措施，旨在帮助女性在怀孕前优化健康和福祉，可以改善妊娠结局，得到了包括疾病控制与预防中心和美国妇产科医师学会在内的国家组织的推荐。使用退伍军人事务部（VA）医疗保健系统的女性退伍军人由于慢性医疗和心理健康状况以及心理社会压力因素（包括性创伤史和亲密伴侣暴力）的高发，可能面临不良妊娠和生育结局的风险增加。许多处于生育年龄的女性退伍军人经历贫困和无家可归，这是生殖健康不良结局的关键社会决定因素。此外，孕产妇和新生儿结局的种族/民族差异有充分记录，近一半的育龄女性退伍军人属于少数种族/民族。因此，为该人群提供高质量、公平、以患者为中心的 PCC 服务以解决可改变的风险是 VA 的优先事项。在本文中，我们简要介绍了 PCC 的背景，讨论了与不良妊娠结局相关的退伍军人的健康风险，并强调了与 PCC 相关的 VA 计划。最后，我们讨论了在 VA 内部以及其他卫生系统中进行 PCC 研究和政策的影响和未来方向。
