Last Updated: August 2019

Author: Division of Maternal and Child Health, Vermont Department of Health

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a survey of women who recently gave birth that asks about their experiences and behaviors before, during and shortly after their pregnancy:

Highlights on Preconception Health & Family Planning from 2017 PRAMS include:

• 77% of women had a visit to a health care provider during the 12 months before pregnancy. Of these:
  • 80% were asked about what kind of work they did;
  • 68% were asked if someone was hurting them emotionally or physically;
  • 66% were asked if they were feeling down or depressed;
  • 56% were asked whether they wanted to have or not have children;
  • 45% had a talk about using birth control;
  • 47% were told to take a vitamin with folic acid;
  • 42% had a discussion about maintaining a healthy weight;
  • 35% had a talk about improving health before a pregnancy;
  • 25% had a talk about STIs;
  • 25% were tested for HIV.
• 38% of women talked to a doctor, nurse or other health care workers about preparing for a pregnancy. Topics included:
  • 54% - getting their vaccines updated before pregnancy;
  • 52% - the safety of medicines during pregnancy;
  • 49% - how drinking during pregnancy can affect a baby;
  • 47% - visiting a dentist/dental hygienist before pregnancy;
  • 44% - how smoking during pregnancy can affect a baby;
  • 42% - how illegal drugs during pregnancy can affect a baby;
  • 27% - counseling or treatment for depression or anxiety;
  • 25% - counseling for genetic diseases.
• 33% of births resulted from unintended pregnancies.
• 90% of women with a prenatal care visit were asked if they planned to use birth control after their babies were born.
• 22% of women smoked cigarettes in the 3 months prior to pregnancy.
• 68% of women drank alcohol during the three months
• 19% of women used a substance other than tobacco or alcohol during the month before pregnancy
• 2% of women used methadone, Suboxone®, or another maintenance treatment drug during the 12 months before pregnancy
• 59% of women had a teeth cleaning during pregnancy.
• 20% of women had depression at some point during the three months before pregnancy

• Offices of Local Health, Maternal and Child Health Coordinators

• Primary care provider practices
• Planned Parenthood of Northern New England
• Department of Vermont Health Access
• Oregon Foundation for Reproductive Health

The importance of preconception care has become a focal point across the country and is part of a broader approach to preventive reproductive health.

Preconception health refers to the health of women and men during their reproductive years, which are the years they can have a child. It focuses on taking steps now to protect the health of a baby they might have sometime in the future.However, all women and men can benefit from preconception health, whether or not they plan to have a baby one day. This is because part of preconception health is about people getting and staying healthy overall, throughout their lives.

More women who are choosing pregnancy are older, may struggle with chronic medical conditions, and take medications regularly. A preconception health visit can improve the chances of a healthy pregnancy by screening for conditions that pose a risk to the pregnancy or the infant. Additionally, only about one‐third of women take folic acid daily before becoming pregnant to prevent major birth defects of the brain and spinal cord.

While most primary care providers would address concerns about contraception or preconception care if the woman raised the issue, the aim is to make preventive reproductive health care proactive that occurs as a standard in health care.Screening women for their pregnancy intentions in primary care promises to decrease unintended pregnancy and improve the overall health of pregnancies.

The One Key Question Initiative:

One Key Question™ is a national initiative that was developed by the Oregon Foundation for Reproductive Health.In 2012 the Vermont Department of Health partnered with the Oregon Foundation for Reproductive Health to implement the initiative in Vermont.The initiative arose in an effort to reduce the number of unintended pregnancies and to improve the rate of preconception health counseling. Unintended pregnancies are known to have worse health outcomes both for mother and infant, as well as extensive social effects such as increasing family stressors, increasing the need for financial support programs, and increasing the risk for family violence.

One Key Question promotes that all women of reproductive age should be screened for their pregnancy intentions on a routine basis as part of high-quality primary care.The purpose of One Key Question is to increase the proportion of pregnancies that are planned, wanted and as healthy as possible by linking preconception health and family planning by a single question asked in a primary care visit.

The One Key Question initiative encourages primary care health teams to routinely ask women age 18‐50 "Would you like to become pregnant in the next year?" Women are then offered supports and services based on their needs.

If a woman answers "yes" to the question then preconception counselling should be conducted.Preconception care includes screening for conditions that can affect pregnancy: medication review, risk assessment, counselling on nutrition, exercise, substance use, recommending folic acid daily, and early prenatal care.If she responds "no", then contraceptive counseling is conducted.

• Promote national resources on preconception health and counseling, such as Before, Between and Beyond Pregnancy: http://beforeandbeyond.org/
• Support Offices of Local Health to promote One Key Question to women of reproductive age and primary care practices in their communities.
• Expand One Key Question to additional Vermont primary care practices by helping them identify opportunities to implement the initiative as part of a quality improvement project.
• Disseminate tools to primary care providers to support implementation.
• Future efforts will focus on developing and implementing a preconception health strategic plan, with One Key Question as a core component.

Similar to statewide efforts, local partners are using data to drive local strategy. For regional data on Maternal and Infant Health indicators, check out our Public Health Data Explorer.

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.

In 2017, the wording of the preconception health questions in PRAMS was changed. The new wording used for this measure is: "Before you got pregnant with your new baby, did a doctor, nurse or other health care worker talk to you about preparing for a pregnancy?” As a result, the data cannot be directly compared to prior years.

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.

The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate file. Each participating state samples between 1,300 and 3,400 women per year. Women from some groups are sampled at a higher rate to ensure adequate data are available in smaller but higher risk populations. Selected women are first contacted by mail. If there is no response to repeated mailings, women are contacted and interviewed by telephone. Data collection procedures and instruments are standardized to allow comparisons between states.