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INTRODUCTION: Differences in healthcare utilization and medical expenditures associated with perinatal depression are estimated. METHODS: Using the MarketScan Multi-State Medicaid Database, the analytic cohort included individuals aged 15–44 years who had an inpatient live birth delivery hospitalization between January 1, 2017 and December 31, 2018. Multivariable negative binomial regression models were used to estimate the differences in utilization associated with perinatal depression, and multivariable generalized linear models were used to estimate the differences in expenditures associated with perinatal depression. Analyses were conducted in 2021. RESULTS: The cohort included 330,593 individuals. Nearly 17% had perinatal depression. Compared with individuals without perinatal depression individuals with perinatal depression had a larger number of inpatient admissions (0.19, 95% CI=0.18, 0.20), total inpatient days (0.95, 95% CI=0.92, 0.97), outpatient visits (14.02, 95% CI=13.81, 14.22), emergency department visits (1.70, 95% CI=1.66, 1.74), and weeks of drug therapy covered by a prescription (28.70, 95% CI=28.12, 29.28) and larger total expenditures ($5,078, 95% CI=$4,816, $5,340). Non-Hispanic Black individuals had larger differences in utilization and expenditures for inpatient services and outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. Hispanic individuals had larger differences in utilization for outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. CONCLUSIONS: Individuals with perinatal depression had more healthcare utilization and medical expenditures than individuals without perinatal depression, and differences varied by race/ethnicity. The findings highlight the need to ensure comprehensive and equitable mental health care to address perinatal depression.

To describe clinician screening practices for prior hypertensive disorders of pregnancy, knowledge of future risks associated with hypertensive disorders of pregnancy, barriers and facilitators to referrals for cardiovascular disease risk evaluation in women with prior hypertensive disorders of pregnancy, and variation by clinician- and practice-level characteristics.We used data from Fall DocStyles 2020, a cross-sectional, web-based panel survey of currently practicing U.S. clinicians. Of 2,231 primary care physicians, obstetrician-gynecologists (ob-gyns), nurse practitioners, and physician assistants invited to participate, 67.3% (n=1,502) completed the survey. We calculated the prevalence of screening, knowledge of future risks, and barriers and facilitators to referrals, and assessed differences by clinician type using χ2 tests. We evaluated associations between clinician- and practice-level characteristics and not screening using a multivariable log-binomial model.Overall, 73.6% of clinicians screened patients for a history of hypertensive disorders of pregnancy; ob-gyns reported the highest rate of screening (94.8%). Overall, 24.8% of clinicians correctly identified all cardiovascular risks associated with hypertensive disorders of pregnancy listed in the survey. Lack of patient follow-through (51.5%) and patient refusal (33.6%) were the most frequently cited barriers to referral. More referral options (42.9%), patient education materials (36.2%), and professional guidelines (34.1%) were the most frequently cited resources needed to facilitate referrals. In the multivariable model, primary care physicians and nurse practitioners, as well as physician assistants, were more likely than ob-gyns to report not screening (adjusted prevalence ratio 5.54, 95% CI 3.24-9.50, and adjusted prevalence ratio 7.42, 95% CI 4.27-12.88, respectively). Clinicians seeing fewer than 80 patients per week (adjusted prevalence ratio 1.81, 95% CI 1.43-2.28) were more likely to not screen relative to those seeing 110 or more patients per week.Three quarters of clinicians reported screening for a history of hypertensive disorders of pregnancy; however, only one out of four clinicians correctly identified all of the cardiovascular risks associated with hypertensive disorders of pregnancy listed in the survey.

In this study, hospital discharge data from the 2016–2017 Healthcare Cost and Utilization Project were analyzed to describe national and, where data were available, state-specific prevalences of chronic hypertension and pregnancy-associated hypertension at delivery hospitalization. In 2016–2017, the prevalence of chronic hypertension was 216 per 10,000 delivery hospitalizations nationwide, ranging from 125 to 400 per 10,000 delivery hospitalizations in individual states. The prevalence of pregnancy-associated hypertension was 1021 per 10,000 delivery hospitalizations nationwide, ranging from 693 to 1382 per 10,000 delivery hospitalizations in individual states. The burden of hypertensive disorders in pregnancy remains high and varies considerably by jurisdiction.

Objectives: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August–October 2021. Methods: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. Results: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non–food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. Conclusions: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.

Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used ...

Introduction: Hypertension is a leading risk factor for cardiovascular disease in the US. Approximately one in ten to one in six women of reproductive age (WRA; aged 18-44 years) have hypertension. Control of hypertension through lifestyle behaviors and anti-hypertensive medication can prevent complications across the life course. Characterizing the current use of anti-hypertensive medication among WRA by urban/rural status offers opportunities to inform public health action. Methods: Data from 59,407 WRA responding to the 2019 Behavioral Risk Factor Surveillance System was used to determine hypertension prevalence from 49 states (New Jersey did not meet data collection standards), District of Columbia, Guam, and Puerto Rico. Among the subset of 6,855 who self-reported hypertension, estimates of current anti-hypertensive medication use were calculated. Prevalence ratios were used to estimate the association between urban/rural status and self-reported use of anti-hypertensive medications, adjusting for age, race/ethnicity, education, and insurance status. Results: The estimated hypertension prevalence among WRA was 10.7% (95%CI:10.3%-11.1%) with 14.0% (95%CI:12.7%-15.5%) in rural and 10.4% (95%CI:10.0%-10.9%) in urban counties. An estimated 45.1% (95%CI:43.1%-47.2%) of WRA with hypertension reported currently using anti-hypertensive medication with estimates of 57.1% (95%CI:51.9%-62.1%) in rural and 44.0% (95%CI:41.9%-46.2%) in urban counties. WRA with hypertension living in rural counties were 1.29 times (95%CI:1.17-1.41) more likely to report currently using anti-hypertensive medication compared to those living in urban counties. Conclusion: Less than half of WRA with hypertension were currently using anti-hypertensive medication. Living in rural counties was associated with a higher frequency of use of anti-hypertensive medication. Ensuring appropriate blood pressure control through engagement in healthy lifestyle behaviors and appropriate use of medication when needed in WRA can improve cardiovascular health and reduce disparities.

Background The COVID-19 pandemic has affected mental health and created barriers to healthcare. In this study, we sought to elucidate the pandemic's effects on mental health and access to care for perinatal individuals. Methods This cross-sectional study of individuals in Massachusetts who were pregnant or up to three months postpartum with a history of depressive symptoms examined associations between demographics and psychiatric symptoms (via validated mental health screening instruments) and the COVID-19 pandemic's effects on mental health and access to care. Chi-square associations and multivariate regression models were used. Results Of 163 participants, 80.8% perceived increased symptoms of depression and 88.8% of anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD at time of interview, higher education, and income were associated with increased symptoms of depression and anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD were also associated with perceived changes in access to mental healthcare. Compared to non-Hispanic White participants, participants of color (Black, Asian, Multiracial, and/or Hispanic/Latinx) were more likely to report that the pandemic changed their mental healthcare access (aOR:3.25, 95%CI:1.23, 8.59). Limitations Limitations included study generalizability, given that participants have a history of depressive symptoms, and cross-sectional design. Conclusions The pandemic has increased symptoms of perinatal depression and anxiety and impacted perceived access to care. Self-reported increases in depression and anxiety and changes to healthcare access varied by education, race/ethnicity, income, and positive screens. Understanding these differences is important to address perinatal mental health and provide equitable care.

Introduction: The American Heart Association (AHA) promotes ideal cardiovascular health (CVH) to reduce the risk of heart disease and stroke by achieving seven metrics (normal weight, not smoking, ≥5 fruits and vegetables daily, physical activity ≥150 minutes per week, no diabetes, no high blood pressure, and no high cholesterol). Overall, about 5% of the adult population report ideal CVH. Characterizing CVH among women of reproductive age (WRA; 18-44 years of age) offers opportunities to promote overall cardiovascular and preventive health along the life course. Methods: Data from the 2019 Behavioral Risk Factor Surveillance System was used to estimate define CVH categories (poor, intermediate, ideal) among 38,012 WRA from 49 states (New Jersey didn’t meet standards for weighting), District of Columbia, Guam, and Puerto Rico. Per commonly used standards, having > 6 metrics defined ideal CVH, 3-5 metrics defined intermediate, and 0-2 metrics defined poor CVH. A generalized logit model was used to estimate the associations between race/ethnicity and education with CVH (poor vs intermediate CVH, and ideal vs. intermediate CVH), accounting for age and insurance status. Results: Overall, 8.6% (95%CI:8.2-9.1%) of WRA reported poor CVH, 85.4% (95%CI: 84.8-86.1) reported intermediate CVH, and 6.0% (95%CI:5.5-6.5) reported ideal CVH. Non-Hispanic Black (NHB) WRA had higher odds of reporting poor vs. intermediate CVH (AOR=1.34; 95%CI:1.14-1.58) and lower odds of reporting ideal vs. intermediate CVH (AOR=0.47; 95%CI:0.33-0.68) compared to non-Hispanic White WRA. College graduates also had lower odd of reporting poor vs. intermediate CVH (AOR=0.21; 95%CI:0.17-0.27) and higher odds of reporting ideal vs. intermediate CVH (AOR=2.59; 95%CI:1.52-4.43) compared to those with less than a high school education. Conclusion: Most WRA have intermediate CVH, nearly 1 in 10 have poor CVH, and only about 1 in 16 have ideal CVH. The CVH metric used in this study provides evidence of the disproportionate burden of poor CVH among NHB WRA and women with less than a college degree. Understanding the barriers to ideal CVH for WRA, particularly social and structural determinants, may improve cardiovascular health and reduce disparities across the life course.

Background Clinical practices can use telemedicine and other strategies (e.g., self-measured blood pressure [SMBP]) for remote monitoring of hypertension to promote control while decreasing risk of exposure to SARS-CoV-2, the virus that causes COVID-19. Methods The DocStyles survey collected data from primary care providers (PCPs), obstetricians-gynecologists (OB/GYNs), and nurse practitioners/physician assistants (NP/PAs) in fall 2020 (n = 1,502). We investigated clinical practice changes for monitoring hypertension that were implemented early in the COVID-19 pandemic and examined differences by clinician and practice characteristics (P < 0.05). Results Overall, 369 (24.6%) of clinicians reported their clinical practices made no changes in monitoring hypertension early in the pandemic, 884 (58.9%) advised patients to monitor blood pressure at home or a pharmacy, 699 (46.5%) implemented or increased use of telemedicine for blood pressure monitoring visits, and 545 (36.3%) reduced the frequency of office visits for blood pressure monitoring. Compared with NP/PAs, PCPs were more likely to advise SMBP monitoring (adjusted prevalence ratios [aPR] 1.28, 95% confidence intervals [CI] 1.11–1.47), implement or increase use of telemedicine (aPR 1.23, 95% CI 1.04–1.46), and reduce the frequency of office visits (aPR 1.37, 95% CI 1.11–1.70) for blood pressure monitoring, and less likely to report making no practice changes (aPR 0.63, 95% CI 0.51–0.77). Conclusions We noted variation in clinical practice changes by clinician type and practice characteristics. Clinical practices may need additional support and resources to fully maximize telemedicine and other strategies for remote monitoring of hypertension during pandemics and other emergencies that can disrupt routine health care.

BACKGROUND To explore the prevalence, pharmacologic treatment, and control of hypertension among US nonpregnant women of reproductive age by race/Hispanic origin to identify potential gaps in care. METHODS We pooled data from the 2011 to March 2020 (prepandemic) National Health and Nutrition Examination Survey cycles. Our analytic sample included 4,590 nonpregnant women aged 20–44 years who had at least 1 examiner-measured blood pressure (BP) value. We estimated prevalences and 95% confidence intervals (CIs) of hypertension, pharmacologic treatment, and control based on the 2003 Joint Committee on High Blood Pressure (JNC 7) and the 2017 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines. We evaluated differences by race/Hispanic origin using Rao–Scott chi-square tests. RESULTS Applying ACC/AHA guidelines, hypertension prevalence ranged from 14.0% (95% CI: 12.0, 15.9) among Hispanic women to 30.9% (95% CI: 27.8, 34.0) among non-Hispanic Black women. Among women with hypertension, non-Hispanic Black women had the highest eligibility for pharmacological treatment (65.5%, 95% CI: 60.4, 70.5); current use was highest among White women (61.8%, 95% CI: 53.8, 69.9). BP control ranged from 5.2% (95% CI: 1.1, 9.3) among women of another or multiple non-Hispanic races to 18.6% (95% CI: 12.1, 25.0) among Hispanic women. CONCLUSIONS These findings highlight the importance of monitoring hypertension, pharmacologic treatment, and control by race/Hispanic origin and addressing barriers to equitable hypertension care among women of reproductive age.

To describe national, state-specific, and sociodemographic trends in diagnoses of depressive disorders recorded during delivery hospitalizations.Data were analyzed from the National Inpatient Sample (2000-2015) and 31 publicly available State Inpatient Databases (2000-2015) of the Healthcare Cost and Utilization Project. Delivery hospitalizations were identified by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes for obstetric delivery. Depressive disorders were identified from ICD-9-CM diagnoses codes classified as depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (291.89, 292.84, 293.83, 296.2-296.26, 296.3-296.36, 300.4, and 311). Prevalence rates and average annual rate change were calculated nationally and across 28 states with at least 3 years of data and age, payer source, and race or ethnicity.The U.S. rate of depressive disorders recorded during delivery hospitalizations increased from 4.1 diagnoses per 1,000 hospitalizations in 2000 to 28.7 in 2015. Rates significantly increased in 27 of the 28 states. Recent (2014-2015) rates were lowest in Hawaii and Nevada (less than 14/1,000) and highest in Vermont, Minnesota, Oregon, and Wisconsin (greater than 49/1,000). Rates in 2015 were highest among those aged 35 years or older, public insurance recipients, and non-Hispanic white women (greater than 31/1,000). The highest annual rate increases were in Vermont and Maine (3.8/1,000 or greater). Non-Hispanic white women, those 35 years of age or older, and public insurance recipients showed the highest annual rate increases during 2000-2015 (1.7/1,000 or greater).During 2000-2015, rates of depressive disorders recorded during delivery hospitalizations increased nationally, in 27 states with available data, and across all sociodemographic categories.

Objective Perinatal depression is a common pregnancy complication and universal screening is recommended. The Practice Readiness to Evaluate and address Perinatal Depression (PREPD) was developed to measure obstetric practice readiness to integrate depression care into workflows. Objectives were to describe: (1) the PREPD; (2) associated characteristics by readiness level; and (3) use of the assessment to measure change. Method The PREPD has four components, each scored to a 16-point maximum: (1) Environmental Scan (10% of PREPD); (2) Depression Detection, Assessment, and Treatment Questionnaire (30%); (3) Depression-related Policies Questionnaire (10%); and (4) Chart Abstraction (50%). Components were weighted and summed for an overall score. Summary and component scores were calculated by patient, practice, and provider. Results Average overall PREPD score was 7.3/16 (range: 4.8–9.9); scores varied between practices. The Environmental Scan averaged 2.0/16 (range: 0–5.2); Detection, Assessment, and Treatment averaged 8.3/16 (range: 3.0–11.5); Chart Abstraction averaged 7.2/16 (range: 5.1–9.6); and Depression-related Policies averaged 10.4/16 (range: 7.5–15). Conclusion We found wide variation in obstetric practices’ readiness to implement interventions for depression; most were minimally prepared. These data may be used to tailor practice intervention goals and as benchmarks with which to measure changes in integration of depression care over time.

INTRODUCTION: Postpartum care is an important strategy for preventing and managing chronic disease in women with pregnancy complications (i.e., gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP)). METHODS: Using a population-based, cohort study among Oregon women with Medicaid-financed deliveries (2009–2012), we examined Medicaid-financed postpartum care (postpartum visits, contraceptive services, and routine preventive health services) among women who retained Medicaid coverage for at least 90 days after delivery (n = 74,933). We estimated postpartum care overall and among women with and without GDM and/or HDP using two different definitions: 1) excluding care provided on the day of delivery, and 2) including care on the day of delivery. Pearson chi-square tests were used to assess differential distributions in postpartum care by pregnancy complications (p < .05), and generalized estimating equations were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Of Oregon women who retained coverage through 90 days after delivery, 56.6–78.1% (based on the two definitions) received any postpartum care, including postpartum visits (26.5%−71.8%), contraceptive services (30.7–35.6%), or other routine preventive health services (38.5–39.1%). Excluding day of delivery services, the odds of receiving any postpartum care (aOR 1.26, 95% Cl 1.08–1.47) or routine preventive services (aOR 1.32, 95% Cl 1.14–1.53) were meaningfully higher among women with GDM and HDP (reference = neither). DISCUSSION: Medicaid-financed postpartum care in Oregon was underutilized, it varied by pregnancy complications, and needs improvement. Postpartum care is important for all women and especially those with GDM or HDP, who may require chronic disease risk assessment, management, and referrals.

Hypertension is one of the largest modifiable risk factors for cardiovascular disease in the United States, and when it occurs during pregnancy, it can lead to serious risks for both the mother and child. There is currently no nationwide or state surveillance system that specifically monitors hypertension among women of reproductive age (WRA). We reviewed hypertension information available in the Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), and Pregnancy Risk Assessment and Monitoring System (PRAMS) health surveys, the Health care Cost and Utilization Project administrative data sets (National Inpatient Sample, State Inpatient Databases, Nationwide Emergency Department Sample, and State Emergency Department Database and the Nationwide Readmissions Database), and the National Vital Statistics System. BRFSS, NHIS, and NHANES and administrative data sets have the capacity to segment nonpregnant WRA from pregnant women. PRAMS collects information on hypertension before and during pregnancy only among women with a live birth. Detailed information on hypertension in the postpartum period is lacking in the data sources that we reviewed. Enhanced data collection may improve opportunities to conduct surveillance of hypertension among WRA.

INTRODUCTION: Chronic diseases in the United States are the leading drivers of disability, death, and health care costs. In women of reproductive age (WRA), chronic disease and related risk factors can also affect fertility and reproductive health outcomes. This analysis of trends from 2011 to 2017 adds additional indicators and updates an analysis covering 2001–2009. METHODS: Data from the 2011–2017 Behavioral Risk Factor Surveillance System were analyzed for 265,544 WRA (18–44 years). To assess trends in 12 chronic conditions and related risk factors, we calculated annual prevalence estimates and adjusted prevalence ratios (APRs) with predicted marginals accounting for age, race, Hispanic ethnicity, education, and health care coverage. RESULTS: From 2011 to 2017, prevalence decreased for current smoking (20.7%–15.9%; p < 0.001), gestational diabetes (3.1%–2.7%; p = 0.003), and high cholesterol (19.0%–16.7%; p < 0.001); prevalence increased for depression (20.4%–24.9%; p < 0.001) and obesity (24.6%–27.6%; p < 0.001). After adjustment, in 2017 WRA were more likely to report asthma (APR = 1.06; 95% confidence interval [CI] = 1.01–1.11), physical inactivity (APR = 1.08; 95% CI = 1.04–1.12), obesity (APR = 1.15; 95% CI = 1.11–1.19), and depression (APR = 1.29; 95% CI = 1.25–1.34) compared with 2011. They were less likely to report high cholesterol (APR = 0.89; 95% CI = 0.85–0.94) in 2015 compared with 2011, and current smoking (APR = 0.86; 95% CI = 0.82–0.89) and gestational diabetes (APR = 0.84; 95% CI = 0.75–0.94) in 2017 compared with 2011. CONCLUSIONS: Some chronic conditions and related risk factors improved, whereas others worsened over time. Research clarifying reasons for these trends may support the development of targeted interventions to promote improvements, potentially preventing adverse reproductive outcomes and promoting long-term health.

Exposure to violence can harm women's overall health and well-being. Data suggest that one in three women in the United States experience some form of violence by an intimate partner in their lifetime. In this commentary, we describe the implications of intimate partner violence (IPV) on women's health, specifically for women of reproductive age. We use a life-course perspective to describe the compounded impact of IPV on preconception health. Preconception health generally refers to the overall health and well-being of women (and men) before pregnancy. This report also discusses primary prevention of IPV and healthcare recommendations, and highlights surveillance systems that capture IPV indicators among women of reproductive age. Ongoing collection of state-level surveillance data may inform the implementation of intervention programs tailored to reproductive age women at risk for IPV.

Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning.We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices.In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62).Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.

Diabetes during pregnancy can adversely affect the health of women and infants. In this report, we provide an overview of the state of the science, and highlight Centers for Disease Control and Prevention (CDC) activities related to (1) surveillance of preexisting and gestational diabetes mellitus (GDM); (2) preconception care for women with preexisting diabetes; (3) postpartum diabetes screening among women with GDM-affected pregnancies; and (4) preventing the progression to Type 2 diabetes among women with GDM-affected pregnancies through lifestyle intervention programs. Improving preconception care, increasing postpartum diabetes screening rates, and promoting lifestyle interventions in the postpartum period all provide opportunities to improve the health of women and their infants.

OBJECTIVES: In response to an expressed need for more focused measurement of preconception health, we identify a condensed set of preconception health indicators for state and national surveillance. METHODS: We used a systematic process to evaluate, prioritize, and select 10 preconception health indicators that maternal and child health programs can use for surveillance. For each indicator, we assessed prevalence, whether it was included in professional recommendations, Healthy People 2020 objectives, Centers for Disease Control and Prevention winnable battles, measurement simplicity, data completeness, and stakeholders’ input. RESULTS: A total of 50 preconception health indicators were evaluated and prioritized. The condensed set includes indicators that rely on data from the Pregnancy Risk Assessment Monitoring System (n=4) and the Behavioral Risk Factor Surveillance System (n=6). The content encompasses heavy alcohol consumption, depression, diabetes, folic acid intake, hypertension, normal weight, recommended physical activity, current smoking, unwanted pregnancy, and use of contraception. CONCLUSIONS: Having a condensed set of preconception health indicators can facilitate surveillance of reproductive-aged women’s health status that supports monitoring, comparisons, and benchmarking at the state and national levels.

Problem/condition Receipt of key preventive health services among women and men of reproductive age (i.e., 15-44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age. Period covered 2011-2013. Description of the system Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15-44 years. This report uses data from the 2011-2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver live-born infants in the United States. Annual PRAMS data sets are created and used to produce statewide estimates of preconception and perinatal health behaviors and experiences. This report uses PRAMS data for 2011-2012 from 11 states (Hawaii, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, Utah, Vermont, and West Virginia). The National Health Interview Survey (NHIS) is a nationally representative survey of noninstitutionalized civilians in the United States. NHIS collects data on a broad range of health topics, including the prevalence, distribution, and effects of illness and disability and the services rendered for or because of such conditions. Households are identified through a multistage probability household sampling design, and estimates are produced using weights that account for the sampling design, nonresponse, and poststratification adjustments. This report uses data from the 2013 NHIS for women aged 18-44 years. Results Many preventive health services recommended in QFP were not received by all women and men of reproductive age. For contraceptive services, including contraceptive counseling and advice, 46.5% of women aged 15-44 years at risk for unintended pregnancy received services in the past year, and 4.5% of men who had vaginal intercourse in the past year received services in that year. For sexually transmitted disease (STD) services, among all women aged 15-24 years who had oral, anal, or vaginal sex with an opposite sex partner in the past year, 37.5% were tested for chlamydia in that year. Among persons aged 15-44 years who were at risk because they were not in a mutually monogamous relationship during the past year, 45.3% of women were tested for chlamydia and 32.5% of men were tested for any STD in that year. For preconception care and related preventive health services, data from selected states indicated that 33.2% of women with a recent live birth (i.e., 2-9 months postpartum) talked with a health care professional about improving their health before their most recent pregnancy; of selected preconception counseling topics, the most frequently discussed was taking vitamins with folic acid before pregnancy (81.2%), followed by achieving a healthy weight before pregnancy (62.9%) and how drinking alcohol (60.3%) or smoking (58.2%) during pregnancy can affect a baby. Nationally, among women aged 18-44 years irrespective of pregnancy status, 80.9% had their blood pressure checked by a health care professional and 31.7% received an influenza vaccine in the past year; 54.5% of those with high blood pressure were tested for diabetes, 44.9% of those with obesity had a health care professional talk with them about their diet, and 55.2% of those who were current smokers had a health professional talk with them about their smoking in the past year. Among all women aged 21-44 years, 81.6% received a Papanicolaou (Pap) test in the past 3 years. Receipt of certain preventive services varied by age and race/ethnicity. Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy increased with age (range: 25.9% and 25.2% for women aged ≤19 and 20-24 years, respectively, to 35.9% and 37.8% for women aged 25-34 and ≥35 years, respectively). Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy was higher for non-Hispanic white (white) (35.2%) compared with non-Hispanic black (black) (30.0%) and Hispanic (26.0%) women. Conversely, across most STD screening services evaluated, testing was highest among black women and men and lowest among their white counterparts. Receipt of many preventive services recommended in QFP increased consistently across categories of family income and continuity of health insurance coverage. Prevalence of service receipt was highest among women in the highest family income category (>400% of federal poverty level [FPL]) and among women with insurance coverage for each of the following: contraceptive services among women at risk for unintended pregnancy; medical services beyond advice to help achieve pregnancy; vaccinations (hepatitis B and human papillomavirus [HPV], ever; tetanus, past 10 years; influenza, past year); discussions with a health care professional about improving health before pregnancy and taking vitamins with folic acid; blood pressure and diabetes screening; discussions with a health care professional in the past year about diet, among those with obesity; discussions with a health care professional in the past year about smoking, among current smokers; Pap tests within the past 3 years; and mammograms within the past 2 years. Interpretation Before 2014, many women and men of reproductive age were not receiving several of the preventive services recommended for them in QFP. Although differences existed by age and race/ethnicity, across the range of recommended services, receipt was consistently lower among women and men with lower family income and greater instability in health insurance coverage. Public health action Information in this report on baseline receipt during 2011-2013 of preventive services for women and men of reproductive age can be used to target improvements in the use of recommended services through the development ofresearch priorities, information for decision makers, and public health practice. Health care administrators and practitioners can use the information to identify subpopulations with the greatest need for preventive services and make informed decisions on resource allocation. Public health researchers can use the information to guide research on the determinants of service use and factors that might increase use of preventive services. Policymakers can use this information to evaluate the impact of policy changes and assess resource needs for effective programs, research, and surveillance on the use of preventive health services for women and men of reproductive age.

CONTEXT Federal and clinical guidelines recommend integrating reproductive life plan assessments into routine family planning encounters to increase provision of preconception care. Yet, the prevalence of clinical protocols and of relevant practices at publicly funded health centers is unknown. METHODS Administrators and providers at a nationally representative sample of publicly funded health centers that provide family planning services were surveyed in 2013–2014; data from 1,039 linked pairs were used to explore the reported prevalence of reproductive life plan protocols, frequent assessment of patients’ reproductive life plan and frequent provision of preconception care. Chi-square tests and multivariable general linear models were used to examine differences in reports of protocols and related practices. RESULTS Overall, 58% of centers reported having reproductive life plan assessment protocols, 87% reported frequently assessing reproductive life plans and 55% reported frequently providing preconception care. The proportions reporting protocols were lower in community health centers than in other center types (32% vs. 52–91%), in primary care centers than in those with another focus (33% vs. 77–80%) and in centers not receiving Title X funding than in those with such support (36% vs. 77%). Reported existence of a written protocol was positively associated with reported frequent assessment (prevalence ratio, 1.1), and the latter was positively associated with reported frequent preconception care (1.4). CONCLUSION Further research is needed on associations between written protocols and clinical practice, and to elucidate the preconception care services that may be associated with reproductive life plan assessment.

Women with chronic diseases are at increased risk of having unintended pregnancies. Little is known whether chronic diseases are associated with increased likelihood of effective/highly effective contraceptive use.We analyzed 2008-2010 Florida Behavioral Risk Factor Surveillance System data for women aged 18-44 years who were at risk of unintended pregnancy. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for contraceptive use in relation to diabetes, cardiovascular disease (CVD), and current asthma. We assessed the association of chronic disease status with use of three different contraception outcomes: (1) any method versus none, (2) less effective methods (methods associated with ≥10 unintended pregnancies/100 women/year) versus none, and (3) effective/highly effective methods (10 unintended pregnancies/100 women/year) versus none.Among 4473 women at risk for unintended pregnancy, 87% were using any method of contraception (22.5% less effective methods and 64.5% effective/highly effective methods). Women with CVD were more likely than those without CVD to use any contraception (aPR = 1.09, 95% CI: 1.04, 1.15), less effective (aPR = 1.39, 95% CI: 1.13, 1.70), and effective/highly effective (aPR = 1.10, 95% CI: 1.03, 1.19) contraception. Women with diabetes were more likely to use less effective methods than women without diabetes (aPR = 1.34, 95% CI: 1.05, 1.72). No significant associations were observed for asthma, regardless of contraceptive effectiveness.Self-reported use of effective/highly effective contraception was higher than nonuse or use of less effective methods among all women at risk of unintended pregnancy, but could be improved, especially among women with chronic diseases.

Background Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil. Methods We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18–44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates. Results Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1–1.2)), smoking (aRR = 1.7 (1.3–2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6–2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1–1.2)), smoking (aRR = 1.4 (1.1–1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1–1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors. Conclusion Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil., Highlights • Examine prevalence of NCD risk factors with race, education, and insurance status • We analyzed data from a probabilistic sample of 13,745 non-pregnant Brazilian women. • Less educated women reported more physical inactivity, smoking, and hypertension. • Uninsured women reported more physical inactivity, smoking and hypertension. • Less variation was found by race and noncommunicable disease risk factors.

Bipolar disorder affects 2-8% of pregnant and postpartum women; untreated illness is associated with poor outcomes. This study aimed to describe bipolar disorder screening rates in obstetric settings and associated characteristics.Women were recruited during pregnancy through three months postpartum from 14 obstetric clinics in Massachusetts. The Mood Disorder Questionnaire (MDQ) was used to screen for bipolar disorder; a subset previously diagnosed with bipolar was also examined. Differences in characteristics by screening outcome were tested using chi-square and t-tests.Of 574 participating women, 18.8% screened positive for bipolar disorder. Compared to those with negative, those with positive bipolar screens had 18.5-times the prevalence of positive substance use screens (11.1% vs. 0.6%, p 0.001) and 3.4-times reported feeling they were not receiving adequate psychiatric help (24.0 vs. 7.0%, p 0.001). Less than half of those with positive bipolar screens (42.0%) and 61.3% with pre-existing bipolar reported receiving current psychiatric care.Almost one in five perinatal women screened positive for bipolar disorder. Positive screenings were associated with comorbid substance use and low treatment rates. This study highlights the importance of screening for bipolar disorder during the perinatal period and the need for systematic approaches to ensure adequate assessment and follow-up.ClinicalTrials.gov identifier: NCT02760004.

Background Perinatal depression, the most common pregnancy complication, is associated with negative maternal-offspring outcomes. Despite existence of effective treatments, it is under-recognized and under-treated. Professional organizations recommend universal screening, yet multi-level barriers exist to ensuring effective diagnosis, treatment, and follow-up. Integrating mental health and obstetric care holds significant promise for addressing perinatal depression. The overall study goal is to compare the effectiveness of two active interventions: (1) the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a state-wide, population-based program, and (2) the PRogram In Support of Moms (PRISM) which includes MCPAP for Moms plus a proactive, multifaceted, practice-level intervention with intensive implementation support. Methods This study is conducted in two phases: (1) a run-in phase which has been completed and involved practice and patient participant recruitment to demonstrate feasibility for the second phase, and (2) a cluster randomized controlled trial (RCT), which is ongoing, and will compare two active interventions 1:1 with ten Ob/Gyn practices as the unit of randomization. In phase 1, rates of depressive symptoms and other demographic and clinical features among patients were examined to inform practice randomization. Patient participants to be recruited in phase 2 will be followed longitudinally until 13 months postpartum; they will have 3–5 total study visits depending on whether their initial recruitment and interview was at 4–24 or 32–40 weeks gestation, or 1–3 months postpartum. Sampling throughout pregnancy and postpartum will ensure participants with different depressive symptom onset times. Differences in depression symptomatology and treatment participation will be compared between patient participants by intervention arm. Discussion This manuscript describes the full two-phase study protocol. The study design is innovative because it combines effectiveness with implementation research designs and integrates critical components of participatory action research. Our approach assesses the feasibility, acceptance, efficacy, and sustainability of integrating a stepped-care approach to perinatal depression care into ambulatory obstetric settings; an approach that is flexible and can be tailored and adapted to fit unique workflows of real-world practices. Trial registration ClinicalTrials.gov Identifier: NCT02760004, registered prospectively on May 3, 2016. Electronic supplementary material The online version of this article (10.1186/s12884-019-2387-3) contains supplementary material, which is available to authorized users.

In 2006, the Preconception Care (PCC) Work Group and the Select Panel on PCC published 10 recommendations promoting preconception health (PCH) and healthcare for women of reproductive age. In the years following the recommendations, much research focused on specific PCH behaviors, clinical provision of care, and care financing, but no comprehensive, well-defined set of indicators was identified. In 2011, seven states developed a set of 45 PCH indicators; however, to date, no one publication has assessed the usefulness of all 45 indicators in addressing PCH. This report makes the case for reducing the original 45 indicators to a condensed set of 10 for national and state reporting by describing the use of the 45 indicators to date, describing development of evaluation criteria for narrowing the number of indicators, and identifying gaps in indicator development for provision of PCC. Using the condensed set, states can set priorities, revise and develop programs and policies, implement system changes, and better allocate resources to support interventions to improve the health of women of reproductive age during the preconception and interconception periods.

Cardiovascular disease (CVD) screening in Title X settings can identify low-income women at risk of future chronic disease. This study examines follow-up related to newly identified CVD risk factors in a Title X setting.Female patients at a North Carolina Title X clinic were screened for CVD risk factors (n=462) and 167/462 (36.1%) were rescreened one year later. Clinical staff made protocol-driven referrals for women identified with newly diagnosed CVD risk factors. We used paired t-tests and chi square tests to compare screening and rescreening results (two-tailed, p0.05).Among 11 women in need of referrals for newly diagnosed hypertension or diabetes, 9 out of 11 (81.8%) were referred, and 2 of 11 (18.2%) completed referrals. Among hypertensive women who were rescreened (n=21), systolic blood pressure decreased (139 to 132 mmHg, p=0.001) and diastolic blood pressure decreased (90 to 83 mmHg, p=0.006). Hemoglobin A1c did not improve among rescreened diabetic women (n=5, p=0.640). Among women who reported smoking at enrollment, 129 of 148 (87.2%) received cessation counseling and 8 of 148 (5.4%) accepted tobacco quitline referrals. Among smokers, 53 out of 148 (35.8%) were rescreened and 11 of 53 (20.8%) reported nonsmoking at that time. Among 188 women identified as obese at enrollment, 22 (11.7%) scheduled nutrition appointments, but only one attended. Mean weight increased from 221 to 225 pounds (p 0.05) among 70 out of 188 (37.2%) obese women who were rescreened.The majority of women in need of referrals for CVD risk factors received them. Few women completed referrals. Future research should examine barriers and facilitators of referral care among low-income women.

Problem/condition Preconception health is a broad term that encompasses the overall health of nonpregnant women during their reproductive years (defined here as aged 18-44 years). Improvement of both birth outcomes and the woman's health occurs when preconception health is optimized. Improving preconception health before and between pregnancies is critical for reducing maternal and infant mortality and pregnancy-related complications. The National Preconception Health and Health Care Initiative's Surveillance and Research work group suggests ten prioritized indicators that states can use to monitor programs or activities for improving the preconception health status of women of reproductive age. This report includes overall and stratified estimates for nine of these preconception health indicators. Reporting period 2013-2015. Description of systems Survey data from two surveillance systems are included in this report. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing state-based, landline and cellular telephone survey of noninstitutionalized adults in the United States aged ≥18 years that is conducted by state and territorial health departments. BRFSS is the main source of self-reported data for states on health risk behaviors, chronic health conditions, and preventive health services primarily related to chronic disease in the United States. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing U.S. state- and population-based surveillance system administered collaboratively by CDC and state health departments. PRAMS is designed to monitor selected maternal behaviors, conditions, and experiences that occur before, during, and shortly after pregnancy that are self-reported by women who recently delivered a live-born infant. This report summarizes BRFSS and PRAMS data on nine of 10 prioritized preconception health indicators (i.e., depression, diabetes, hypertension, current cigarette smoking, normal weight, recommended physical activity, recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method) for which the most recent data are available. BRFSS data from all 50 states and the District of Columbia were used for six preconception health indicators: depression, diabetes (excluded if occurring only during pregnancy or if limited to borderline/prediabetes conditions), hypertension (excluded if occurring only during pregnancy or if limited to borderline/prehypertension conditions), current cigarette smoking, normal weight, and recommended physical activity. PRAMS data from 30 states, the District of Columbia, and New York City were used for three preconception health indicators: recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method by women or their husbands or partners (i.e., male or female sterilization, hormonal implant, intrauterine device, injectable contraceptive, oral contraceptive, hormonal patch, or vaginal ring). Heavy alcohol use during the 3 months before pregnancy also was included in the prioritized set of 10 indicators, but PRAMS data for each reporting area are not available until 2016 for that indicator. Therefore, estimates for heavy alcohol use are not included in this report. All BRFSS preconception health estimates are based on 2014-2015 data except two (hypertension and recommended physical activity are based on 2013 and 2015 data). All PRAMS preconception health estimates rely on 2013-2014 data. Prevalence estimates of indicators are reported for women aged 18-44 years overall, by age group, race-ethnicity, health insurance status, and reporting area. Chi-square tests were conducted to assess differences in indicators by age group, race/ethnicity, and insurance status. Results During 2013-2015, prevalence estimates of indicators representing risk factors were generally highest and prevalence estimates of health-promoting indicators were generally lowest among older women (35-44 years), non-Hispanic black women, uninsured women, and those residing in southern states. For example, prevalence of ever having been told by a health care provider that they had a depressive disorder was highest among women aged 35-44 years (23.1%) and lowest among women aged 18-24 years (19.2%). Prevalence of postpartum use of a most or moderately effective method of contraception was lowest among women aged 35-44 years (50.6%) and highest among younger women aged 18-24 years (64.9%). Self-reported prepregnancy multivitamin use and getting recommended levels of physical activity were lowest among non-Hispanic black women (21.6% and 42.8%, respectively) and highest among non-Hispanic white women (37.8% and 53.8%, respectively). Recent unwanted pregnancy was lowest among non-Hispanic white women and highest among non-Hispanic black women (5.0% and 11.6%, respectively). All but three indicators (diabetes, hypertension, and use of a most or moderately effective contraceptive method) varied by insurance status; for instance, prevalence of current cigarette smoking was higher among uninsured women (21.0%) compared with insured women (16.1%), and prevalence of normal weight was lower among women who were uninsured (38.6%), compared with women who were insured (46.1%). By reporting area, the range of women reporting ever having been told by a health care provider that they had diabetes was 5.0% (Alabama) to 1.9% (Utah), and women reporting ever having been told by a health care provider that they had hypertension ranged from 19.2% (Mississippi) to 7.0% (Minnesota). Interpretation Preconception health risk factors and health-promoting indicators varied by age group, race/ethnicity, insurance status, and reporting area. These disparities highlight subpopulations that might benefit most from interventions that improve preconception health. Public health action Eliminating disparities in preconception health can potentially reduce disparities in two of the leading causes of death in early and middle adulthood (i.e., heart disease and diabetes). Public health officials can use this information to provide a baseline against which to evaluate state efforts to improve preconception health.

Objectives The National Quality Forum (NQF) recently endorsed the first clinical performance measures for contraceptive care. We present data demonstrating that the measures meet the NQF's criterion “importance to measure and report.” Study design We summarized national contraceptive care initiatives, epidemiologic data documenting the reproductive health burden and the scientific literature examining the association between contraceptive use and unintended pregnancy. In addition, we analyzed contraceptive use data from the National Survey of Family Growth (2013–2015) and the Pregnancy Risk Assessment Monitoring System (2012–2013). Results Five Federal agencies lead national initiatives, and two Institute of Medicine reports highlight the centrality of reproductive health outcomes for the health of women and infants. Two literature reviews demonstrate that the type of contraception used is associated with risk of unintended pregnancy. Fifty-three percent of adolescents (15–19 years) and 40% of adult women (20–44 years) at risk of unintended pregnancy are not using a most or moderately effective contraceptive method; in the postpartum period, one third of adolescents (≤19 years) and 44% of adult women (≥20 years) are not using these methods. Conclusions The new contraceptive care measures meet the NQF criterion for “importance to measure and report.” The measures are based on evidence that contraceptive use is associated with reproductive health outcomes, and there is a substantial performance gap in the use of most and moderately effective methods. Implications Using the new contraceptive care measures may motivate providers to increase access to contraceptive care, thereby improving health outcomes.

Relapsing to smoking postpartum jeopardizes a woman's health and her infant's health. Our study estimated the proportion and identified characteristics associated with postpartum relapse using a large population-based sample.We analyzed Pregnancy Risk Assessment Monitoring System data among women with live births. Relapse was defined as smoking at survey completion among those who quit by the last 3 months of pregnancy. We assessed linear trends for relapse during 2000-2011 in 40 sites overall and individually using logistic regression. Adjusted prevalence ratios (aPRs) were calculated to assess characteristics associated with relapse during 2009-2011 (n = 13,076).During 2000-2011, the proportion of women who relapsed postpartum remained unchanged overall (p = 0.84) and by site (p ≥ 0.05 for each), ranging in 2011 from 30.8% to 52.2% (Wyoming-Arkansas). Characteristics associated with relapse compared with reference groups were prepregnancy daily smoking (aPR = 1.80; 95% confidence interval (CI): 1.59-2.04); age20 years (aPR = 1.51; 1.24-1.84), 20-24 years (aPR = 1.39; 1.17-1.65), or 25-34 years (aPR = 1.26; 1.07-1.48); not initiating breastfeeding (aPR = 1.34; 1.24-1.44); not having a complete home smoking ban (aPR = 1.27; 1.14-1.42); being black non-Hispanic (aPR = 1.25; 1.14-1.38); being multiparous (aPR = 1.20; 1.11-1.28); experiencing 3-5 stressors during pregnancy (aPR = 1.12; 1.01-1.24); having an unintended pregnancy (aPR = 1.11; 1.03-1.19); and having 12 years of education (aPR = 1.09; 1.01-1.17).There was no change in the proportion of women relapsing postpartum during 2000-2011. In 2011, nearly half (42%) of women relapsed after quitting smoking during pregnancy. Disparities exist by site and by maternal characteristics. A comprehensive approach maximizing tobacco control efforts and developing effective clinical interventions delivered across sectors is necessary for long-term tobacco abstinence among women.

Introduction Federal recommendations for providing quality family planning services were published in 2014 and included preconception care (PCC). This paper aims to describe the prevalence of PCC delivery among publicly funded clinics, prior to the recommendations. Methods Prevalence of providing occasional or frequent PCC in the last 3 months and having written protocols for recommended PCC screenings were estimated in 2015 using survey data collected from a nationally representative sample of publicly funded clinic administrators (2013–2014, N=1,615). Analyses included examination of differential distributions of outcomes by clinic characteristics ( p Results Prevalence of occasional or frequent PCC delivery was 81% for women and 38% for men. The percentage of clinics with written protocols for specific PCC screenings ranged from 74% to 88% (women) and 66% to 83% (men). Prevalence of having written protocols for all PCC screenings was 29% for women and 22% for men. Characteristics negatively associated with having written protocols for all PCC screenings for women and men (respectively) were as follows: not receiving Title X funding (adjusted prevalence ratio [APR]=0.6, 95% CI=0.50, 0.76; APR=0.6, 95% CI=0.47, 0.77) and being a community health center (APR=0.5, 95% CI=0.37, 0.72; APR=0.5, 95% CI=0.30, 0.67); health department (APR=0.7, 95% CI=0.61, 0.87; APR=0.6, 95% CI=0.49, 0.76); or hospital/other (APR=0.6, 95% CI=0.50, 0.79; APR=0.6, 95% CI=0.43, 0.75) (versus Planned Parenthood). Conclusions Provision of PCC appears to differ by clinic characteristics and by interpretation of the phrase "preconception care," suggesting opportunities for education and improvement.

OBJECTIVE: The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth. STUDY DESIGN: Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization,intrauterinedevice, implants, shots,pills, patch,and ring)and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009e2011). We assessed the differences in contraception by gestational age (� 27, 28e33, or 34e36 weeks vs term [� 37 weeks]) and modeled the associations using multivariable logistic regression with weighted data. RESULTS:Ahigher percentage ofwomen withrecentextreme preterm birth (� 27 weeks) reported using no postpartum method (31%) compared with all other women (15e16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4e0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4e0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15e18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse. CONCLUSION: During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant.

Background: Low-income women of reproductive age are at increased risk for obesity and resulting increases in the risk of maternal/fetal complications and mortality and morbidity. Very few weight-loss interventions, however, have been targeted to this high-risk group. Based on the high prevalence of social media use among young and low-income individuals and previous successes using group formats for weight-loss interventions, the use of social media as a platform for weight-loss intervention delivery may benefit low-income women of reproductive age. Objective: Examine the feasibility of delivering group-based weight-loss interventions to low-income women of reproductive age using face-to-face meetings and Web-based modalities including social media. Methods: Participants attended a family planning clinic in eastern North Carolina and received a 5-month, group- and Web-based, face-to-face weight-loss intervention. Measures were assessed at baseline and 20 weeks. Results: Forty participants enrolled, including 29 (73%) African American women. The mean body mass index of enrollees was 39 kg/m2. Among the 12 women who completed follow-up, mean weight change was -1.3 kg. Participation in the intervention was modest and retention at 5 months was 30%. Returnees suggested sending reminders to improve participation and adding activities to increase familiarity among participants. Conclusions: Engagement with the intervention was limited and attrition was high. Additional formative work on the barriers and facilitators to participation may improve the intervention’s feasibility with low-income women of reproductive age.

OBJECTIVE: The objective of the study was to examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. STUDY DESIGN: The Pregnancy Risk Assessment Monitoring System 2004e2008 data were analyzed from Missouri, New York state, and New York City (n ¼ 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). RESULTS: The majority of women received prenatal (78%) and postpartum(86%)contraceptivecounseling;72%receivedboth.Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR], 2.10; 95% confidence interval [CI], 1.65e2.67) and both time periods (AOR, 2.33; 95% CI, 1.87e2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% vs 49% and 56%, respectively; P for trend < .0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with noinsurance(AOR,3.51;95%CI,2.18e5.66)andMedicaidinsurance (AOR, 3.74; 95% CI, 1.98e7.06) than for those with private insurance (AOR, 1.87; 95% CI, 1.44e2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except that no differences by insurance status were detected. CONCLUSION: The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most.