Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS).
BACKGROUND
Prenatal care provides an opportunity for counseling about behaviors and experiences that increase the likelihood of adverse maternal and fetal outcomes.


OBJECTIVE
To document (1) prevalence of preventive health counseling during prenatal care, (2) prevalence of women in higher need of counseling about specific health concerns, and (3) whether women in higher need for counseling were more likely than women in lower need to have received counseling.


METHODS
Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS), a state-specific, population-based, random sample of postpartum women, was performed by using data from 14 states for births during 1997 or 1998, for a total of 24,620 participants. Outcome measures included report of preventive health counseling during prenatal visits by specific topic as well as behaviors and experiences about cigarette use, alcohol use, breast-feeding, partner violence, and preterm labor.


RESULTS
The percentage of women that report preventive counseling during prenatal care is relatively high (> or =75%) for 9 of 13 topics. However, the percentage of women that report counseling is relatively low (<75%) for partner violence, seat belt use, illegal drug use, and human immunodeficiency virus (HIV) risk. Except for counseling about cigarette and alcohol use, women in higher need, compared with women in lower need, for three other health topics were not significantly more likely to receive counseling.


CONCLUSIONS
Preventive health counseling for partner violence, seat-belt use, illegal drug use, and risk of HIV could be increased across prenatal settings. Counseling should involve assessment of risks, with focused counseling related to those risks.
Petersen
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Cecil G. Sheps Center for Heath Services Research, University of North Carolona, Chapel Hill, North Carolina 27599-7590, USA. ruth_petersen@unc.edu
Connelly
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A
Martin
S L
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Kupper
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LL
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires