Women's preconceptional health and use of health services: implications for preconception care.
OBJECTIVE
To improve understanding of women's use of health care before pregnancy, by analyzing how the health status and health risks of pre- and interconceptional women are associated with health services use.


METHODS
Data are from a cross-sectional random-digit dial telephone survey of a representative sample of 2002 women ages 18-45 years from the Central Pennsylvania Women's Health Study (CePAWHS). A subsample of 1,325 respondents with current reproductive capacity, classified by reproductive life stage (preconceptional or interconceptional), was analyzed.


METHODS
Bivariate and multiple logistic regression analyses were conducted to determine how health needs (including indices of health status and health risks related to adverse pregnancy outcomes) are associated with five indicators of health services use (receipt of a regular physical exam, obstetrician-gynecologist [ob/gyn] visit, receipt of a set of recommended screening services, receipt of health counseling services on general health topics, and receipt of pregnancy-related counseling), controlling for predisposing and enabling variables.


RESULTS
Only half of women at risk of pregnancy report receiving counseling about pregnancy planning in the past year. One-third of women surveyed did not receive routine physical examinations and screening services, and over half received little or no health counseling. Multivariate analyses showed that all the measures of health needs except for negative health behavior were related to some type of health services use. Psychosocial stress was associated with having a recent ob/gyn visit, with receiving general health counseling, and with receiving pregnancy planning counseling. Cardiovascular risk was positively associated with receiving general health counseling and a regular physical exam, but negatively associated with seeing an ob/gyn. Positive health behaviors were associated with receiving screening services and with receiving general health counseling. Preconceptional reproductive life stage was positively associated with receiving a regular physical exam and negatively associated with having an ob/gyn visit.


CONCLUSIONS
Pre- and interconceptional women with specific health care needs may not receive appropriate health care before pregnancy. Improving pregnancy experiences and outcomes requires more comprehensive preconception health care and more preventive care before the first pregnancy.
Hillemeier
Marianne M
MM
Department of Health Policy and Administration, Pennsylvania State University, 116 Henderson, University Park, PA 16802, USA.
Weisman
Carol S
CS
Chase
Gary A
GA
Dyer
Anne-Marie
AM
Shaffer
Michele L
ML
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015984:Causality; D003430:Cross-Sectional Studies; D005260:Female; D005306:Fertilization; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D010414:Pennsylvania / Q000453:epidemiology; D016742:Preconception Care; D011594:Psychometrics; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013997:Time Factors; D016387:Women's Health; D014932:Women's Health Services / Q000706:statistics & numerical data*