Lead/Presenter: Deirdre Quinn, COIN - Pittsburgh/Philadelphia
All Authors: Quinn DA (Center for Health Equity and Research and Promotion, Pittsburgh), Mor, M.K. (Center for Health Equity Research and Promotion, Pittsburgh), Sileanu, F.E. (Center for Health Equity Research and Promotion, Pittsburgh) Zhao, X. (Center for Health Equity Research and Promotion, Pittsburgh) Callegari, L.S.(Health Services Research and Development, VA Puget Sound Health Care System; Department of Obstetrics & Gynecology, University of Washington School of Medicine) Borrero, S. (Center for Health Equity Research and Promotion, Pittsburgh; Center for Research on Health Care, University of Pittsburgh School of Medicine)
In 2016, the Clinical Workgroup of the National Preconception Health and Health Care Initiative proposed nine wellness measures to assess the quality of preconception care in healthcare systems. As the largest integrated health care system in the U.S., VA is uniquely positioned to lead the way in implementing and evaluating efforts, including preconception care, to improve birth outcomes. This study is the first comprehensive assessment of VA's performance on measures of preconception wellness.
We examined VA national administrative data, including inpatient, outpatient, and fee-basis visits, lab and pharmacy data, and health factors screening data for women Veterans ages 18-45 with at least one pregnancy outcome (ectopic pregnancy, spontaneous abortion, stillbirth, and/or live birth) during FY 2010-2015. We used last menstrual period (LMP), estimated from gestational age at the time of pregnancy outcome, as a reference point to assess documentation of eight preconception indicators.
We identified 26,556 pregnancies from 21,234 women Veterans. Just over half (56.6%) were in non-Hispanic white women, 23.4% in non-Hispanic black women, and 10.9% in Hispanic women; women's mean age at LMP was 29.8. 45.2% of pregnancies had no documentation of prenatal care within 14 weeks of LMP; 44.4% had no documented tobacco use screening and 49% had no documented depression screening within 1 year prior to LMP. Almost a third (29.5%) of pregnancies occurred in women with obesity. Only 40.2% of pregnancies in women with pregestational diabetes (n = 286) had a documented optimal HbA1c measurement ( < 6.5) in the year prior to LMP. Evidence of any STI screening in the year prior to 3 months post LMP was low, as was documentation of prenatal folic acid use (9.0% in the 3 months prior to LMP). Only 5% of pregnancies had evidence of exposure to six classes of known teratogenic medications in the year prior to LMP.
Areas for intervention to improve women Veterans' preconception wellness were identified, including weight reduction, optimizing control of diabetes prior to pregnancy, and improved use and documentation of routine health screenings.
Despite the limitations of existing administrative data, monitoring standard measures of preconception wellness can provide benchmarks for improving women's health across healthcare systems.