MPA | Pharmacy News

By Mollie M. Reidenbach, Pharm.D., pharmacy practice resident, SpartanNash, Byron Center

 

Preconception care is defined as a set of interventions that work toward identifying and modifying biomedical, behavioral and social risks to women’s health or pregnancy outcomes through prevention and management.1,2 It refers to the healthcare a woman or man receives during the years in which they are able to have a child and focuses on taking steps now to protect the health of a baby they might have in the future.3 Many pregnancies have good maternal and fetal outcomes; however, in the U.S., about 30 percent of women experience complications during pregnancy leading to 12 percent of babies being born prematurely, eight percent born with a low birth weight and three percent having major birth defects.2 In addition, pregnancy complications and their aftermath impart a large economic burden with direct and indirect healthcare system costs totaling over one million dollars over the course of that child’s life.2

Several studies show that almost all women who are planning to become pregnant have at least one risk factor that could adversely affect their pregnancy.4 Complications can occur at any stage of pregnancy; however, most birth defects occur within the first three months of pregnancy during fetal organ development.3 Because almost half of all pregnancies in the U.S. are unplanned, women may not be aware of pregnancy until the fetus has moved well into the vulnerable period. This results in an alarming amount of women who are not taking the necessary precautions to prevent complications.3,5 Given this information, timing of prenatal care is key.2 Preconception care should not only target patients who are actively pursuing pregnancy, but also the 62 million women of childbearing age in the U.S. who are capable of becoming pregnant.5,6 Although not all negative occurrences can be avoided, optimizing women’s health and knowledge before conception may help to reduce these risks.5

The Centers for Disease Control and Prevention (CDC) Select Panel on Preconception Care developed 14 proven interventions for preconception care: diabetes, hypothyroidism, maternal phenylketonuria (PKU), oral anticoagulation, antiepileptic medications, isotretinoin use, HIV/AIDs, sexually transmitted infections (STIs), vaccinations, folic acid, smoking cessation, alcohol/drug misuse and obesity.3,7 While much of this can be addressed in the primary care setting, many patients cannot afford routine doctor visits, and providers may find it difficult to address every need within one appointment. Pharmacists can help bridge this gap. In a study by Mager et al., select community pharmacies in Ohio implemented preconception care targeted medication reviews into the pharmacy workflow; the interventions included folic acid supplementation, hepatitis B/MMR vaccination and category D/X medication use.8 The study demonstrated the feasibility of this type of counseling within the community pharmacy setting. With 90 percent of Americans living within a five mile radius of a pharmacy, and medication therapy management (MTM) platforms providing avenues for these types of services to be implemented, pharmacists are in an excellent position to provide those services for their patients.9 Should we begin implementing preconception care-based counseling among women of child-bearing age within the community pharmacy setting? The answer should be a resounding “yes.”

If yes, what are the next steps? Preconception care services are quickly becoming a “hot topic” in healthcare, and the need for these services is well defined. In time, more research and recommendations regarding community pharmacy driven preconception care services will become available. As we begin to learn more about the need for preconception care and how it fits into community pharmacy practice, I leave you with this: where might preconception care services fit within your pharmacy workflow, and how might you implement these types of services to better the health of the patients you serve? 

For more information, visit the CDC’s website: https://www.cdc.gov/preconception/index.html

References:
1.      Preconception care: A guide to optimizing outcomes. ACOG [internet]. 2013 Sept [cited 2017 Sept 2]. Available from: https://www.health.ny.gov/publications/2026/
2.      Proceedings: Kent H, Johnson K, Curtis M, Hood JR, Atrash H. Proceedings of the preconception health and health care clinical, public health, and consumer work group meetings. CDC, National Center on Birth Defects and Developmental Disabilities [internet]. 2006 Jun 27-28 [cited 2017 Sept 1]. Available from: https://www.cdc.gov/preconception/documents/workgroupproceedingsjune06.pdf
3.      Preconception health and healthcare. CDC [internet]. 2017 Feb 13 [cited 2017 Sept 1]. Available from: https://www.cdc.gov/preconception/index.html
4.      Poels M, Van Stel HF, Franx A, Koster MPH. Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period. Midwifery [internet]. 2017 Apr 26 [cited 2017 Sept 1]; 228-234. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28478375
5.      The importance of preconception care in the continuum of women’s health care. ACOG [internet]. 2005 Sept [cited 2017 Sept 1]; 313. Available from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Importance-of-Preconception-Care-in-the-Continuum-of-Womens-Health-Care
6.      Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, Boulet S, Curtis MG. Recommendations to improve preconception health and health care --- United States. A report of the CDC/ATSDR preconception care work group and select panel on preconception care. CDC MMWR [internet]. 2006 Apr 21 [cited 2017 Sept 1]; 55(RR06):1-23. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm
7.      DiPietro N. Preconception care: an overview. US Pharmacist [internet]. 2008 Sept 18 [cited 2017 Sept 1]; 33(9): 34-42. Available from: https://www.uspharmacist.com/article/preconception-care
8.      DiPietro NA, Bright DR, Markus D, Weis L, Hartzell DM, Gartner J. Use of targeted medication reviews to deliver preconception care: a demonstrative project. J Am Pharm Assoc [internet]. 2017 Jan-Feb [cited 2017 Sept 1]; 57(1): 90-94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27838391
9.      Frederick J. By the numbers: how community pharmacists measure up. DSN [internet]. 2015 Mar 13 [cited 2017 Sept 1]. Available from: http://www.drugstorenews.com/article/numbers-how-community-pharmacists-measure

Bookmark and Share  

Search for
Pharmacy News