Family Forum / Parenting / Adoption / May 2006

In case you haven't figured out yet that women are nothing more than baybee
machines....

Marley
http://www.washingtonpost.com/wp-dyn/content/article/2006/05/15/AR2006051500875_
pf.html

Forever Pregnant
Guidelines: Treat Nearly All Women as Pre-Pregnant

By January W. Payne
Washington Post Staff Writer
Tuesday, May 16, 2006; HE01

New federal guidelines ask all females capable of conceiving a baby to treat
themselves -- and to be treated by the health care system -- as
pre-pregnant, regardless of whether they plan to get pregnant anytime soon.

Among other things, this means all women between first menstrual period and
menopause should take folic acid supplements, refrain from smoking, maintain
a healthy weight and keep chronic conditions such as asthma and diabetes
under control.

While most of these recommendations are well known to women who are pregnant
or seeking to get pregnant, experts say it's important that women follow
this advice throughout their reproductive lives, because about half of
pregnancies are unplanned and so much damage can be done to a fetus between
conception and the time the pregnancy is confirmed.

The recommendations aim to "increase public awareness of the importance of
preconception health" and emphasize the "importance of managing risk factors
prior to pregnancy," said Samuel Posner, co-author of the guidelines and
associate director for science in the division of reproductive health at the
Centers for Disease Control and Prevention (CDC), which issued the report.

Other groups involved include the American College of Obstetricians and
Gynecologists, the March of Dimes, Dartmouth Hitchcock Medical Center, the
National Center for Chronic Disease Prevention's Division of Reproductive
Health and the National Center on Birth Defects and Developmental
Disabilities.

The idea of preconception care has been discussed for nearly 20 years,
experts said, but it has drawn more attention recently. Progress toward
further reducing the rate of unhealthy pregnancy results, including
premature birth, low birthweight and infant mortality, has slowed in the
United States since 1996 "in part because of inconsistent delivery and
implementation of interventions before pregnancy to detect, treat and help
women modify behaviors, health conditions and risk factors that contribute
to adverse maternal and infant outcomes," according to the report.

Nearly 28,000 U.S. infants died in 2003, according to the National Center
for Health Statistics (NCHS). The infant mortality rate increased in 2002
for the first time in more than 40 years to seven deaths per 1,000 live
births, but it did not change significantly in 2003. Birth defects, low
birthweight and sudden infant death syndrome (SIDS) were the leading causes
of infant death in 2003, according to NCHS.

The U.S. infant mortality rate is higher than those of most other
industrialized nations -- it's three times that of Japan and 2.5 times those
of Norway, Finland and Iceland, according to a report released last week by
Save the Children, an advocacy group.

Preconception care should be delivered by any doctor a patient sees -- from
her primary care physician to her gynecologist. It involves developing a
"reproductive health plan" that details if and when children are planned,
said Janis Biermann, a report co-author and vice president for education and
health promotion at the March of Dimes.

"The recommendations say we need to be opportunistic," or deliver care and
counseling when opportunities arise, said Merry-K. Moos, a professor in the
University of North Carolina's maternal fetal medicine division who sat on
the CDC advisory panel. "Healthier women have healthier pregnancies."

Women should also make sure all vaccinations are up-to-date and avoid
contact with lead-based paints and cat feces, Biermann said.

The report recommends that women stop smoking and discuss with their doctor
the danger alcohol poses to a developing fetus.

Research shows that "during the first few weeks (before 52 days' gestation)
of pregnancy" -- during which a woman may not yet realize she's pregnant --  
"exposure to alcohol, tobacco and other drugs; lack of essential vitamins
(e.g., folic acid); and workplace hazards can adversely affect fetal
development and result in pregnancy complications and poor outcomes for both
the mother and the infant," the report states.

The CDC report also discusses disparities in care, noting that approximately
17 million women lack health insurance and are likely to postpone or forgo
care. These disparities are more prominent among minority groups and those
of lower socioeconomic status, the report states.

The NCHS data also reflect these disparities. Babies born to black mothers,
for example, had the highest rate of infant death -- 13.5 per 1,000 live
births. Infants born to white women had a death rate of 5.7 per 1,000.

Obstacles to preconception care include getting insurance companies to pay
for visits and putting the concept into regular use by doctors and patients.
Experts acknowledge that women with no plans to get pregnant in the near
future may resist preconception care.

"We know that women -- unless you're actively planning [a pregnancy], . . .
she doesn't want to talk about it," Biermann said. So clinicians must find a
"way to do this and not scare women," by promoting preconception care as
part of standard women's health care, she said.

Some medical facilities have already found a way to weave preconception care
in with regular visits. At Montefiore Medical Center in Bronx, N.Y., a form
that's filled out when checking a patient's height, weight and blood
pressure prompts nurses to ask women, "Do you smoke, and do you plan to
become pregnant in the next year? And if not, what birth control are you
using?"

"It's a simple way of getting primary care providers to think about
preconception care," said Peter Bernstein, a maternal fetal medicine
specialist who sat on the advisory committee that helped produce the report.
"It's simple and [it] costs nothing."