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Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative

Frayne, Daniel J. MD; Verbiest, Sarah DrPH, MSW; Chelmow, David MD; Clarke, Heather CNM, DNP; Dunlop, Anne MD; Hosmer, Jennifer MD, MPH; Menard, M. Kathryn MD, MPH; Moos, Merry-K. BSN, MPH; Ramos, Diana MD, MPH; Stuebe, Alison MD, MSc; Zephyrin, Laurie MD, MPH

doi: 10.1097/AOG.0000000000001379
Contents: Consensus Statement

Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements.

Supplemental Digital Content is Available in the Text.The National Preconception Health and Healthcare Initiative recommends that health care systems adopt nine preconception wellness measures to drive improvements in birth outcomes.

Corresponding author: Daniel J. Frayne, MD, 123 Hendersonville Road, Asheville, NC 28803; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

For a list of Consensus Panel Members and their affiliations, see Appendix 1 online at

Funding for the consensus meeting received through the W. K. Kellogg Foundation.

The authors thank the members of the Clinical Workgroup Consensus Panel for their time and expertise in development of these recommendations, the W. K. Kellogg Foundation for financial support of the in-person meeting, and Suzanne Yergenson for manuscript assistance.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.