Partner violence, seat-belt use among issues overlooked during pregnancy counseling

April 20, 2001

Although most pregnant women receive counseling on a number of health topics, some women with special risks are not getting the advice they need, according to the results of a new study.

"This study suggests the need to individualize counseling for each patient according to her personal behaviors and experiences," says lead study author Ruth Petersen, M.D., M.P.H., of the University of North Carolina.

To date, few studies have examined how often pregnant women are asked about preventive health topics. Prenatal care is a perfect time to provide preventive health counseling, since most women receive some form of prenatal care, says Petersen.

"Poor pregnancy outcomes can often be linked to a limited number of high risk behaviors such as substance use and poor diet, which can be modified by behavioral changes," notes Petersen.

To determine how often women were counseled on relevant health topics during pregnancy, Petersen and colleagues analyzed data from a government survey of nearly 25,000 postpartum women. The researchers based their list of relevant topics on recommendations from the U.S. Preventive Services Task Force.

A majority of the topics were well covered by healthcare practitioners: more than 80 percent of the surveyed women reported counseling on cigarette and alcohol use, nutrition, breast-feeding, pre-term labor, family planning after pregnancy, medication use during pregnancy, fetal growth and development, and HIV testing, the researchers found.

Other topics relevant to pregnant women were less likely to be addressed, including partner violence, with a counseling rate of 31 percent; seat belt use, 53 percent; illegal drug use, 73 percent; and HIV risks, 51 percent.

The study is published in the May issue of the American Journal of Preventive Medicine.

Also, for certain topics, counseling was not targeted to the needs of individual women. Those in higher need of counseling on breast feeding, partner violence, and pre-term labor, for example, received no more counseling on these topics than other women. In contrast, pregnant women who smoked and used alcohol were more likely to receive counseling on these subjects than women who didn't smoke or drink, the researchers found.

"Preventive health practice guidelines may need to include efficient, effective and reliable ways to assess patients' risks and to provide focused counseling according to those risks," notes Petersen.

The researchers note their reliance on patient recall rather than provider records as a study limitation. They also call for more research on the degree to which counseling improves women's health during pregnancy, as well as on the best counseling methods.
This study was supported in part by a National Research Service Award Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality, sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.

The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at 619-594-7344.

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