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Semin Reprod Med 2018; 36(06): 327-339
DOI: 10.1055/s-0039-1678753
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preconception Care in the Veterans Health Administration

Lisa S. Callegari
1   Seattle-Denver Center of Innovation for Veteran - Centered and Value-Drived Care, VA Puget Sound Health Care System, Seattle, Washington
2   Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
,
Stephanie W. Edmonds
3   Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
,
Sonya Borrero
4   Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
5   Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Ginny L. Ryan
3   Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
6   Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Caitlin M. Cusack
7   VA Central Office, Women's Health Services, Washington, District of Columbia
8   Insight Informatics, Washington, District of Columbia
,
Laurie C. Zephyrin
7   VA Central Office, Women's Health Services, Washington, District of Columbia
9   New York Harbor VA Healthcare System, New York, New York
10   Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
19 April 2019 (online)

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Abstract

Preconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.

Keywords

women veterans - preconception care - prepregnancy - maternal outcomes - pregnancy outcomes - family planning - social determinants of health - health equity - health system
 

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