Preconception Care for Improving Perinatal Outcomes: The Time to Act

Abstract

A healthy baby and a healthy mother are valued hopes and dreams of families of all cultural heritages. National health goals in many countries around the world prioritize infant and maternal mortality and morbidity. In the United States, as in many other industrialized countries, pregnancy outcomes and maternal and infant health indicators have improved dramatically. At the turn of the 20th century, 7.28 women and 96 infants died for every 1,000 babies born alive [ 1 ]. By the end of the year 2000, the maternal mortality rate had decreased to less than 0.08 and infant mortality had decreased to less than 7 deaths per 1,000 live births [ 2 ]. These changes were characterized as one of the ten “great public health achievements” of the 20th century [ 3 ]. Much of this progress can be attributed to changes in social and living conditions as well as the development and implementation of effective medical interventions. Despite this progress, during the last two decades of the 20th century, even in the presence of significant breakthroughs in medical technology and its application, improvements in maternal and infant pregnancy ouctomes slowed down significantly, and in some cases, outcomes deteriorated. For example, from 1960 to 1980, the maternal mortality rate decreased from 32.1 to 9.4 deaths per 100,000 live births, a decrease of 70.7%. From 1980 to 2000, the maternal mortality rate decreased only 12.8%, from 9.4 to 8.2 (Figure 1 ) [ 2 ]. At the same time, from 1980 to 2000, the proportion of babies born preterm, very preterm, low birth weight, and very low birth weight increased by 26%, 8.2%, 14.7% and 25.9%, respectively (Figure 2 ) [ 4 ]. However, unlike other maternal and infant health indicators, from 1980 to 2000 the infant mortality rate continued to decrease almost at a similar pace as that from 1960 to 1980, dropping by 45.2% from 12.6 to 6.9 infant deaths per 1,000 live births, compared with a drop of 51.5% from 26.0 to 12.6 per 1,000 live births for 1960 to 1980 (Figure 1 ) [ 2 ]. Finally, it is estimated that the proportion of babies born in the United States who have a serious or major structural defect that can have adverse effects on their health or development continues to be about 3% [ 5 ].