Extended Prenatal Care Could Help to Better Address Chronic Illness


WASHINGTON — The term “prenatal care” should be rethought to include much more of a woman's life cycle, Dawn Misra, Ph.D., said at a meeting sponsored by the Jacobs Institute of Women's Health.

“We have to go beyond the [typical] prenatal period” of a few months before pregnancy, said Dr. Misra of the University of Michigan, Ann Arbor. When it comes to chronic illnesses that may affect pregnancy, for example, “we have to plan strategies to address these matters across the life course; if we want to fix them, we can't wait until pregnancy to [address] them.”

Dr. Misra gave hypertension as an example. “There really is no good treatment for hypertension once you're pregnant,” she said. “You can do some things to try to moderate its effects and lessen its impact, but you can't fix it. So [instead] we could prevent women from having hypertension and entering pregnancy with hypertension.” This involves addressing such chronic health problems in the preconception period as well as between pregnancies.

She gave several reasons why providers haven't taken this approach. “Public health and medical professionals are wedded to the notion that prenatal care is fundamental,” she said. “There have been a lot of successes with prenatal care, but I would like to take a step back and think about how prenatal care is not the only answer.”

The health care financing system has encouraged this model of prenatal care by the way it reimburses for care, she continued. As a result, “very few women get no prenatal care, yet we haven't achieved much improvement in terms of infant outcomes.”

Changing this system of care would also mean increasing involvement by providers outside the specialty of ob.gyn., such as pediatricians, Dr. Misra said. “Pediatricians are taking care of future mothers. They could spend time from that perspective thinking about chronic illnesses, keeping [these patients] well, and thinking about what future concerns might be.”

Some of these changes might be fostered by improving medical school training. In addition, people from outside the medical profession such as coaches and personal trainers could be involved in these types of issues, she said.

Pediatricians could also help provide better record transfer, Dr. Misra noted. “We have young girls moving from the pediatrician to the ob.gyn. or the nurse-midwife. A lot is lost when young girls move to those providers, and we need to find better ways to relay their health history.” This is a challenge that needs to be met, especially in the wake of a study showing that 25% of pregnant women have a chronic health condition, Dr. Misra added.

On a broader level, public health officials need to rethink their method of separating chronic disease care from maternal and child health programming, Dr. Misra said. “This may require thinking about how future [pregnancy] outcomes are dependent on preventing these kinds of illnesses.”

One audience member commented that although she liked the speaker's message, “The women's health movement has been struggling for a long time to get away from thinking about women's health merely in terms of maternity and reproduction,” she said. “I think we need to reword language like 'preconceptional.' When we're sitting in this room, we know what we're talking about, but many people out there still think of women as reproductive machines.”

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