Preconception care is individualized health care designed to optimize health prior to pregnancy to reduce future pregnancy complications. Promoting preconception care for preventing pregnancy-related illnesses and death is needed, especially for those who are at highest risk. This study evaluated reception of preconception care among U.S. Black women of reproductive age.
Methods:
This study used Pregnancy Risk Assessment Monitoring System data from 2016 to 2021 with a sample of Black women across 44 states, the District of Columbia, New York City, and Puerto Rico who intended to become pregnant (n = 16,071). Multivariate logistic regression models evaluated the association between prepregnancy hypertension and preconception care reception.
Results:
Hypertensive Black women had 21% decreased odds (odds ratio [OR]: 0.79, confidence interval: 0.72–0.87) of receiving preconception care, compared with their counterparts without prepregnancy hypertension. An inverse dose–response was observed: As education and household income increased, the odds of receiving preconception care services decreased significantly (education: (OR: 1.39–0.64; income: OR: 0.74–0.30).
Conclusions:
These findings affirm that hypertensive Black women had lower odds of receiving preconception care services compared with Black women who did not begin pregnancy with hypertension. Given that women with chronic conditions would have more reasons to receive care prior to pregnancy, this finding is disconcerting.
AzeezO, KulkarniA, KuklinaEV, et al.Hypertension and diabetes in non-pregnant women of reproductive age in the United States. Prev Chronic Dis2019;16:E146.
AtrashH, JackB. Preconception care to improve pregnancy outcomes: The Science. jhgd2020;30(3):355–362.
4.
HarperT, KuohungW, SayresL, et al.Optimizing preconception care and interventions for improved population health. Fertil Steril2023;120(3 Pt 1):438–448.
5.
GoughA, McCanceD, AlderdiceF, et al.Preconception counselling resource for women with diabetes. BMJ Qual Improv Rep2015;4(1):u209621.w3984.
6.
SrinivasuluS, ShahSD, SchechterCB, et al.Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings. Contraception2020;101(3):199–204.
FordND, CoxS, KoJY, et al.Hypertensive disorders in pregnancy and mortality at delivery hospitalization—United States, 2017–2019. MMWR Morb Mortal Wkly Rep2022;71(17):585–591. Available from: https://www.cdc.gov/mmwr/volumes/71/wr/mm7117a1.htm
9.
MarshallCJ, HumaZ, DeardorffJ, et al.Prepregnancy counseling among U.S. women with diabetes and hypertension, 2016–2018. Am J Prev Med2021;61(4):529–536.
10.
BelloJK, RaoG, StulbergDB. Trends in contraceptive and preconception care in United States ambulatory practices. Fam Med2015;47(4):264–271.
TrostS, BeauregardJ, ChandraG, et al.Pregnancy-related deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019. 2022;6.
13.
HoyertDL. Maternal mortality rates in the United States, 2023. 2025.
14.
SmithA, BarrWB, Bassett-NovoaE, et al.Maternity care update: Preconception care. FP Essent2018;467:11–16.
15.
MittalP, DandekarA, HesslerD. Use of a modified reproductive life plan to improve awareness of preconception health in women with chronic disease. Perm J2014;18(2):28–32.
16.
CarsonMP, ChenKK. Hypertension in a woman planning pregnancy. CMAJ2014;186(2):129–130.
SureshS, AmegashieC, PatelE, et al.Racial disparities in diagnosis, management, and outcomes in preeclampsia. Curr Hypertens Rep2022;24(4):87–93.
22.
ChinnJJ, MartinIK, RedmondN. Health equity among black women in the United States. J Womens Health (Larchmt)2021;30(2):212–219.
23.
GeronimusAT. Weathering: the extraordinary stress of ordinary life in an unjust society. First edition. New York: Little, Brown Spark; 2023.
24.
LuMC, HalfonN. Racial and ethnic disparities in birth outcomes: A life-course perspective. Matern Child Health J2003;7(1):13–30.
25.
SimonsRL, LeiMK, BeachSRH, et al.Economic hardship and biological weathering: The epigenetics of aging in a U.S. sample of black women. Soc Sci Med2016;150:192–200.
26.
GeronimusAT. The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethn Dis1992;2(3):207–221.
27.
MinhasAS, OgunwoleSM, VaughtAJ, et al.Racial disparities in cardiovascular complications with pregnancy-induced hypertension in the United States. Hypertension2021;78(2):480–488.
28.
SeelyEW, EckerJ. Chronic hypertension in pregnancy. Circulation2014;129(11):1254–1261.
29.
KattahAG, GarovicVD. The management of hypertension in pregnancy. Adv Chronic Kidney Dis2013;20(3):229–239.
30.
LuY, ChenR, CaiJ, et al.The management of hypertension in women planning for pregnancy. Br Med Bull2018;128(1):75–84.
31.
Commodore-MensahY, Turkson-OcranRA, FotiK, et al.Associations between social determinants and hypertension, stage 2 hypertension, and controlled blood pressure among men and women in the United States. Am J Hypertens2021;34(7):707–717.
32.
BerkmanLF, KawachiI. A historical framework for social epidemiology: Social determinants of population health. In: BerkmanLF, KawachiI, GlymourMM., editors. Social Epidemiology [Internet].Oxford University Press; 2014. pp. 1–16; doi: 10.1093/med/9780195377903.003.0001
33.
BravemanP, GottliebL. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep2014;129(Suppl 2):19–31.
34.
LivingoodWC, BradyC, PierceK, et al.Impact of pre-conception health care: Evaluation of a social determinants focused intervention. Matern Child Health J2010;14(3):382–391.
35.
ShiehC, HalsteadJA. Understanding the impact of health literacy on women’s health. J Obstet Gynecol Neonatal Nurs2009;38(5):601–610; quiz 610–2.
36.
ChuangCH, VelottDL, WeismanCS. Exploring knowledge and attitudes related to pregnancy and preconception health in women with chronic medical conditions. Matern Child Health J2010;14(5):713–719.
37.
VamosCA, ThompsonEL, GrinerSB, et al.Applying organizational health literacy to maternal and child health. Matern Child Health J2019;23(5):597–602.
38.
MartinLT, SchonlauM, HaasA, et al.Patient activation and advocacy: Which literacy skills matter most? J Health Commun2011;16(Suppl 3):177–190.
39.
HalfonN, LarsonK, LuM, et al.Lifecourse health development: Past, present and future. Matern Child Health J2014;18(2):344–365.
ShulmanHB, D’AngeloDV, HarrisonL, et al.The pregnancy risk assessment monitoring system (PRAMS): Overview of design and methodology. Am J Public Health2018;108(10):1305–1313.
43.
Budtz-JørgensenE, KeidingN, GrandjeanP, et al.Confounder selection in environmental epidemiology: Assessment of health effects of prenatal mercury exposure. Ann Epidemiol2007;17(1):27–35.
44.
WengX, WoodruffRC, ParkS, et al.Hypertension prevalence and control among U.S. women of reproductive age. Am J Prev Med2024;66(3):492–502.
45.
BrittonLE, ArciaA, KaurG, et al.“A patient should not have to ask”: Women’s experiences of patient education about preconception care for type 2 diabetes. Patient Educ Couns2023;112:107739.
46.
HowellEA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol2018;61(2):387–399.
47.
MainaIW, BeltonTD, GinzbergS, et al.A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med2018;199:219–229.
48.
RussellS. Eradicating racism from maternity care begins with addressing implicit bias. Nurs Womens Health2021;25(3):167–169.
49.
YadaFN, BrownCS, Brunner HuberLR, et al.Type of attendant at birth by detailed maternal nativity among US-born, Latin American and Caribbean-born, and sub-Saharan African-Born Black Women. Populations2025;1(3):15.
50.
DavisDA. Obstetric racism: The racial politics of pregnancy, labor, and birthing. Med Anthropol2019;38(7):560–573.
51.
ScottKA, DavisDA. Obstetric racism: Naming and identifying a way out of black women’s adverse medical experiences. Am Anthropol2021;123(3):681–684.
GavinL, MoskoskyS. Providing quality family planning services. MMWR Recomm Rep2014;63(4):1–54.
54.
GavinL, PazolK. Update: Providing quality family planning services — Recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep2016;65(9):231–234. Available from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6509a3.htm
55.
ChambersBD, AregaHA, ArabiaSE, et al.Black Women’s perspectives on structural racism across the reproductive lifespan: A conceptual framework for measurement development. Matern Child Health J2021;25(3):402–413.
56.
LeeJY, MurryN, KoJ, et al.Exploring the relationship between maternal health literacy, parenting self-efficacy, and early parenting practices among low-income mothers with infants. J Health Care Poor Underserved2018;29(4):1455–1471.
57.
OribhaborGI, NelsonML, Buchanan-PeartKAR, et al.A mother’s cry: A race to eliminate the influence of racial disparities on maternal morbidity and mortality rates among Black Women in America. Cureus2020;12(7):e9207.
58.
VerbiestS, CenéC, ChambersE, et al.Listening to patients: Opportunities to improve reproductive wellness for women with chronic conditions. Health Serv Res2022;57(6):1396–1407.
59.
HardemanRR, KheyfetsA, ManthaAB, et al.Developing tools to report racism in maternal health for the CDC maternal mortality review information application (MMRIA): Findings from the MMRIA racism & Discrimination Working Group. Matern Child Health J2022;26(4):661–669.
BiermannJ, DunlopAL, BradyC, et al.Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Matern Child Health J2006;10(5 Suppl):S21–S28.
BreslauJ, HanB, LaiJ, et al.Impact of the affordable care act medicaid expansion on utilization of mental health care. Med Care2020;58(9):757–762.
70.
MyersonR, CrawfordS, WherryLR. Medicaid expansion increased preconception health counseling, Folic acid intake, and postpartum contraception. Health Aff (Millwood)2020;39(11):1883–1890.
71.
GardinerP, HempsteadMB, RingL, et al.Reaching women through health information technology: The Gabby preconception care system. Am J Health Promot AJHP2013;27(3 Suppl):eS11–eS20.
72.
WalterAW, JulceC, SidduriN, et al.Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women. BMC Health Serv Res2020;20(1):889.
73.
BombardJM, RobbinsCL, DietzPM, et al.Preconception care: The perfect opportunity for health care providers to advise lifestyle changes for hypertensive women. Am J Health Promot AJHP2013;27(3 Suppl):S43–S49.
74.
NjorogeJN, ParikhNI. Understanding health disparities in cardiovascular diseases in pregnancy among Black Women: Prevalence, preventive care, and peripartum support networks. Curr Cardiovasc Risk Rep2020;14(7):8.
