Disparities in Preconception Health Indicators — Behavioral Risk Factor Surveillance System, 2013–2015, and Pregnancy Risk Assessment Monitoring System, 2013–2014
Authors: Cheryl Robbins, Sheree L. Boulet, Isabel Morgan, Denise V. D’Angelo, Lauren B. Zapata, Brian Morrow, Andrea Sharma, Charlan D. Kroelinger
Journal: MMWR Surveillance Summaries (2018)

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 selfreported 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.MMWR / January 19, 2018 / Vol.67 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention 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 preconconception 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.