Preconception Care in the Veterans Health Administration

Lisa S. Callegari; Stephanie W. Edmonds; Sonya Borrero; Ginny L. Ryan; Caitlin M. Cusack; Laurie C. Zephyrin

doi:10.1055/s-0039-1678753

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2018; 36(06): 327-339
DOI: 10.1055/s-0039-1678753

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preconception Care in the Veterans Health Administration

Lisa S. Callegari

¹Seattle-Denver Center of Innovation for Veteran - Centered and Value-Drived Care, VA Puget Sound Health Care System, Seattle, Washington

²Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington

,

Stephanie W. Edmonds

³Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa

,

Sonya Borrero

⁴Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania

⁵Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

,

Ginny L. Ryan

³Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa

⁶Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, Iowa

,

Caitlin M. Cusack

⁷VA Central Office, Women's Health Services, Washington, District of Columbia

⁸Insight Informatics, Washington, District of Columbia

,

Laurie C. Zephyrin

⁷VA Central Office, Women's Health Services, Washington, District of Columbia

⁹New York Harbor VA Healthcare System, New York, New York

¹⁰Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York

› Author Affiliations

Abstract

Preconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.

Keywords

women veterans - preconception care - prepregnancy - maternal outcomes - pregnancy outcomes - family planning - social determinants of health - health equity - health system

Full Text

References

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