ADDRESSING PRECONCEPTION RISKS IDENTIFIED AT THE TIME OF A NEGATIVE PREGNANCY TEST - A RANDOMIZED TRIAL

BACKGROUND. A preconception care program has the potential to assist w omen who want to become pregnant by advising these women about risk fa ctors, healthy lifestyles, and assessing readiness for pregnancy. We c onducted a randomized controlled trial to determine whether comprehens ive preconception risk assessment at the time of a negative pregnancy test followed by referral to primary care services is effective in ini tiating treatment for women with preconception risk factors. METHODS. One hundred seventy women were offered preconception risk assessment f ollowing a negative pregnancy test. Women were assigned randomly eithe r to a usual care group or an intervention group. Women in the latter group were informed about the risks identified and received an appoint ment with a primary care clinician who was also informed. Women in the usual care group and their clinicians received no feedback. All chart s were reviewed and the women were contacted by telephone to determine if interventions to reduce risk were offered by clinicians during the year following the assessment. RESULTS. An average of 8.96 risks were identified per woman. The proportion of women having risks in each of 12 risk categories studied ranged from 19% to 71%. One hundred women (59%) made at least one visit during the subsequent year, thus allowin g the opportunity for preconception care. The proportion of these wome n who had a risk addressed ranged from 18% for psychosocial risks to 4 8% for those with fetal exposures (smoking, alcohol, and drug use). Th ere was no difference between groups in the percentage of risks addres sed. CONCLUSIONS. The notification of women and their clinicians of id entified preconception risks did not improve intervention rates. A mor e organized intervention system including office-based protocols is ne eded.