Original article| Volume 21, ISSUE 4, P272-276, July 2011

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Preconception Health of Low Socioeconomic Status Women: Assessing Knowledge and Behaviors



      The stalled U.S. infant mortality rate and persistent disparities in adverse pregnancy outcomes may be addressed by optimizing a woman’s health throughout her childbearing years. This study examines women’s knowledge and behaviors related to preconception risk factors in two community health centers serving lower income, racially diverse populations.


      A survey was administered among a convenience sample of women ages 18 to 44 years (n = 340). Questions focused on health behaviors and conditions, knowledge of risk factors, and recommendations of health care providers. Outcomes include the prevalence of risk factors and correlations between the presence of a risk factor and either a respondent’s knowledge or a health care provider’s recommendation. Data were analyzed for total respondents and two subgroups: Black, non-Hispanic and Hispanic.


      Despite strong knowledge of risk factors in the preconception period, high-risk behaviors and conditions existed: 63% of women overweight or obese, 20% drinking alcohol, and 42% taking a multivitamin. Significant differences in risk factors were noted between Black, non-Hispanic and Hispanic respondents. Overweight/obesity (t = 3.0; p < .05) and alcohol use (χ2 = 9.2; p < .05) were higher among Black, non-Hispanics, whereas Hispanic women had lower rates of multivitamin use (χ2 = 11.1; p < .05). The majority of respondents recall being spoken to by a health care provider about pregnancy-related risks. Most risk factors were not influenced by provider’s recommendations, including multivitamin use, drinking alcohol, and smoking. However, birth control use was correlated with a provider’s recommendation (χ2 = 7.6; p < .05). Correlations between the presence of risk factors and respondent’s knowledge existed for immunizations (χ2 = 9.6; p < .05), but not for multivitamin use, drinking alcohol, or smoking.


      Our study identified behaviors amenable to change. Knowledge alone or a doctor’s recommendation are not enough to change those behaviors. Innovative programs and support systems are required to encourage women to adopt healthy behaviors throughout the childbearing years.
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        • Anderson J.E.
        • Ebrahim S.
        • Floyd L.
        • Atrash H.
        Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period—United States, 2002–2004.
        Maternal and Child Health Journal. 2006; 10: 101-106
        • Biermann J.
        • Lang Dunlop A.
        • Brady C.
        • Dubin C.
        • Brann A.
        Promising practices in preconception care for women at risk for poor health and pregnancy outcomes.
        Maternal and Child Health Journal. 2006; 10: S21-S28
        • Centers for Disease Control and Prevention (CDC)
        Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception.
        Morbidity and Mortality Weekly Report. 2006; 55: 1-23
        • Centers for Disease Control and Prevention (CDC)
        Use of supplements containing folic acid among women of childbearing age—United States, 2007.
        Morbidity and Mortality Weekly Report. 2008; 57: 5-8
        • de Jong-van den Berg L.T.W.
        • Hernandez-Diaz S.
        • Werler M.M.
        • Louik C.
        • Mitchell A.A.
        Trends and predictors of folic acid awareness and periconceptional use in pregnant women.
        American Journal of Obstetrics and Gynecology. 2005; 192: 121-128
        • Elsinga J.
        • de Jong-Potjier L.C.
        • van der Pal-de Bruin K.M.
        • le Cessie S.
        • Assendelft J.J.
        • Buitendijk S.E.
        The effect of preconception counseling on lifestyle and other behavior before and during pregnancy.
        Women’s Health Issues. 2008; 18S: S117-S125
        • Frey K.
        • Files J.
        Preconception healthcare: What women know and believe.
        Maternal and Child Health Journal. 2006; 10: S73-S77
        • Hillemeier M.M.
        • Symons Downs D.
        • Feinberg M.E.
        • Weisman C.S.
        • Chuang C.H.
        • Parrott R.
        • et al.
        Improving women’s preconceptional health. Findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women’s health study.
        Women’s Health Issues. 2008; 18S: S87-S96
      1. LeRoy, L. J. (2010, November). Family planning quality improvement projects in Healthy Start communities. Paper presented at the annual meeting of the American Public Health Association. Denver, CO.

      2. March of Dimes. (2010). Peristats. Available: Accessed July 9, 2010.

        • Martin J.A.
        • Hamilton B.E.
        • Sutton P.D.
        • Ventura S.J.
        • Menacker F.
        • Kirmeyer S.
        • et al.
        Births: Final data for 2006. National Vital Statistics Reports, 57.
        National Center for Health Statistics, Hyattsville, MD2009
        • Mathews T.J.
        • MacDorman M.F.
        Infant mortality statistics from the 2006 period linked birth/infant death data set. National Vital Statistics Reports, 58.
        National Center for Health Statistics, Hyattsville, MD2010
      3. National Association of Community Health Centers, Research & Data. (2009). America’s Health Centers, March 2009. Available: Accessed May 6, 2009.

        • Quinn G.P.
        • Hauser K.
        • Bell-Ellison B.A.
        • Rodriguez N.Y.
        • Frias J.L.
        Promoting pre-conceptional use of folic acid to Hispanic women: A social marketing approach.
        Maternal and Child Health Journal. 2006; 10: 403-412
        • Thompson B.K.
        • Peck M.
        • Brandert K.T.
        Integrating preconception health into public health practice: A tale of three cities.
        Journal of Women’s Health. 2008; 17: 723-727
      4. U.S. Census Bureau. (2008). American Community Survey, 1-year estimates. Available: Accessed July 9, 2010.

      5. Wilnesky, S., & Proser, M. (2008). Community approaches to women's health. Delivering preconception care in a community health center model. Women's Health Issues, 18S, S52–S60.


      Linda Harelick, MS, MBA, DrPH(c), is a doctoral candidate in Health Policy and Management at New York Medical College School of Health Sciences and Practice. She completed her internship in the area of preconception health from which the data for this paper is derived. Her dissertation topic focuses on the disparities in oral health status and access issues.


      Deborah Viola, MBA, PhD, is Associate Professor and Associate Director of the Doctoral Program, as well as a Research Scholar at the Center for Long Term Care Research & Policy at New York Medical College School of Health Sciences and Practice. Research interests include regional health care planning, long-term care for the developmentally disabled, caregiving across the lifespan, and the impact of income support policies on population health.


      Denise Tahara, MBA, PhD, is Assistant Professor and Director of MPH Studies at New York Medical College School of Health Sciences and Practice. Her research interests include system-wide performance improvement, preconception healthcare, wellness and chronic disease management education, and sustainability practices in healthcare. Dr. Tahara is a CPA in New York State.