If early is good, is earlier even better?
Educators promoting preconception programs
Buoyed by the successful track record of prenatal education programs, health promotion professionals have taken their efforts one step further: to preconception health education. (A prenatal education program saved CIGNA $2.4 million in 1996. See story, p. 83.)"Most developmental problems occur in the first trimester, so we lose a tremendous opportunity if we don’t get to the parents until the second trimester," explains Kathi Marshall, president and CEO of Marshall Educational Health Solutions, a national wellness education publisher based in Minden, NV. "Think of the impact we could have if we could prepare women for pregnancy."
Her company publishes a 94-page booklet called Prelude to Pregnancy, in which the major topics include:
• a self-assessment quiz (see sample enclosed in this issue);
• physical exam discussion;
• genetic disorders;
• risky behaviors;
• nutrition;
• exercise;
• fertility;
• finances.
"There is a strong need for information about some of the things that you can manage to improve the chances of a healthier pregnancy," adds Rose Bemis-Heys, RNP, an independent consultant in Newport Beach, CA. "For example, if a woman is diabetic, there is some good data that says if we get her sugar levels in control prior to conception and the first critical weeks of development, there will be a reduction in the number of birth defects." (See our summary of preconception literature and commentary, p. 81.)
Chuie Yuen, MD, vice president and medical director of CIGNA Health Care of Southern California, Los Angeles, and professor of herbal medicine and acupuncture at the University of California at Los Angeles (UCLA), says, "I think preconception care is absolutely critical, as basically half of all pregnancies are unplanned. It can really make a difference in terms of the health of the child, as well as your own well-being."
There’s a lot we don’t know
Yuen, who has distributed the Prelude to Pregnancy book at employee health fairs, sees a crying need for preconception education."For example, if you take folic acid early in your pregnancy, you can reduce the risk of brain and spinal damage to the baby by 70%," says Yuen, who also serves on the executive board of the Southern California Chapter of the March of Dimes. "But in a 1995 Gallup survey conducted by the March of Dimes, only 15% of the respondents knew about the requirement for folic acid, and less than 25% who did take it took the proper amount."
Bemis-Heys sees the need for education in a number of other areas: "There’s drug abuse, alcohol abuse, smoking, unhealthy lifestyle, and there are behavioral changes one can begin to focus on," she notes. "There are also issues surrounding genetic birth defects. You can at least give parents the opportunity to understand the risks early on and make better decisions."
Parents can learn much by detailed assessment questionnaires, a component of Prelude to Pregnancy, she says. Women should also learn to adopt a healthy exercise and diet regimen before they become pregnant, says Yuen.
"Carrying extra weight makes you less comfortable and can increase the risk for gestational diabetes," she notes. "Also, you should look at the safety of the medications you are currently on — they might not be indicated if you were pregnant."
Marshall adds that it’s important for both parents to participate in preconception education. The father’s health has a large impact on the health status of the baby. Health factors they should consider include:
• Fathers should know their genetic histories.
• Smoking can reduce the absorption of vitamin C, which can alter the sperm and produce a baby with birth defects.
• It’s just as important for the father as it is for the mother to stop using alcohol; it can lead to a low-birth-weight baby.
• Hot-tubbing can reduce the motility of sperm, which reduces fertility.
• Both parents should be drug-free.
"Pregnancy is a team experience," she says. "Actually, the father and the employer are both critical players."
The Prelude to Pregnancy booklets, which were distributed beginning in the middle of 1994, are reporting mixed results to date.
"We originally used them at health fairs at Allied Signal Corp.," Marshall says. "The employees loved it; the copies flew off the table. Our biggest problem was that employers were not comfortable talking about the subject to employees. They were uncomfortable asking them if they were thinking about becoming pregnant." The problem, says Marshall, is that women are asked this question, and men aren’t, which raises discrimination issues. Also, employers are reluctant to be seen as invading an employee’s privacy. The solution to both problems, Marshall suggests, is to include preconception education as an integral part of you wellness program, and publicly offer it to all employees.
At Minneapolis-based 3M, the publication has been made available through the company newsletter. Interested employees are encouraged to contact the human resources department. "But we haven’t quite figured out how to get it to the masses," admits Marshall.
Yuen is confident that the Marshall program, and others like it, will ultimately gain widespread popularity. "In terms of the health fairs themselves, the books were very popular — it was one of the tables most frequently visited. The book is straightforward, nonjudgmental, and very comprehensive. I believe the public has an unquenchable thirst for information on pregnancy — they’ll talk to friends, go to forums, or go on the internet to find what they want."
Yuen, whose company offers a comprehensive Healthy California Baby educational program, believes employees will also support worksite programs for preconception education.
"It would not be a hard sell in terms of employees, and it would be a good way to reach a large number of people," she asserts. "People today are more interested in looking ahead to the implications of their behaviors. They realize they can individually impact their health to a great extent, and they’re willing to take individual initiative and responsibility for that health."
Unfortunately, says Bemis-Heys, even if preconception education programs do take root, it may be hard to evaluate them.
"It’s difficult to measure success," she notes. "The programs are entirely voluntary, and of course, some of the women don’t even become pregnant."
[Editor’s Note: For more information on preconception programs, contact: Kathi Marshall, Marshall Educational Health Solutions, 1176 Angela Court, Suite 103, Minden, NV 89423-8901. Telephone: (800) 428-8321. Fax: (702) 267-4979. E-mail: [email protected].
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