Preconception Care Between Pregnancies: The Content of Internatal Care

• DOI: 10.1007/s10995-006-0118-7
• Publication Date: 2006-07-02T03:44:04Z
• Authors: Michael C. Lu; Milton Kotelchuck; Jennifer F. Culhane; Calvin J. Hobel; Lorraine V. Klerman; John M. Thorp
• Keywords: Domestic Violence; Time Factors; Epidemiology; Pregnancy, High-Risk; Reproductive health and childbirth; Preconception care; Medical and Health Sciences; 0302 clinical medicine; 5. Gender equality; Pregnancy; Risk Factors; Infant Mortality; Obstetrics and Gynaecology; internatal care; Pediatric; preconception care; Internatal care; Prenatal Care; Gender Equality; 3. Good health; Content; Parity; Mental Health; Studies in Human Society; Premature Birth; Female; Patient Safety; Public Health; Preconception Care; Postnatal Care; 610; Nutritional Status; Health Promotion; Risk Assessment; 03 medical and health sciences; Folic Acid; Clinical Research; interpregnancy; Behavioral and Social Science; Humans; content; Conditions Affecting the Embryonic and Fetal Periods; Pediatrics, Perinatology, and Child Health; Nutrition; Original Paper; Health Priorities; Immunization Programs; Prevention; Contraception/Reproduction; Public Health, Environmental and Occupational Health; preterm birth; Preterm birth; Perinatal Period - Conditions Originating in Perinatal Period; Interpregnancy; United States; Good Health and Well Being; High-Risk

For more than two decades, prenatal care has been a cornerstone of our nation’s strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child. For healthy mothers, internatal care offers an opportunity for wellness promotion between pregnancies. For high-risk mothers, internatal care provides strategies for risk reduction before their next pregnancy. In this paper we begin to define the contents of internatal care. The core components of internatal care consist of risk assessment, health promotion, clinical and psychosocial interventions. We identified several priority areas, such as FINDS (family violence, infections, nutrition, depression, and stress) for risk assessment or BBEEFF (breastfeeding, back-to-sleep, exercise, exposures, family planning and folate) for health promotion. Women with chronic health conditions such as hypertension, diabetes, or weight problems should receive on-going care per clinical guidelines for their evaluation, treatment, and follow-up during the internatal period. For women with prior adverse outcomes such as preterm delivery, we propose an internatal care model based on known etiologic pathways, with the goal of preventing recurrence by addressing these biobehavioral pathways prior to the next pregnancy. We suggest enhancing service integration for women and families, including possibly care coordination and home visitation for selected high-risk women. The primary aim of this paper is to start a dialogue on the content of internatal care.