Prenatal Care

Several new trends in prenatal care efforts have emerged. First, reflecting the popular aphorism that "you can't solve a lifetime of ills in nine months of a pregnancy," there has been an increasing focus on pre-conceptual care. Pre-conceptual care tries to detect and treat key maternal health issues prior to the beginning of the pregnancy. Examples include reduction of smoking, initiation of diabetes treatment, dietary improvement, and family planning. Pre-conceptual care links prenatal/reproductive care to the broader women's health movement. Second, there has been an increasing focus on providing specific "proven" prenatal care content rather than simply increasing the number of generic prenatal care visits. In this way, prenatal care has increasingly focused on such areas as smoking reduction, substance use reduction, diabetes treatment, WIC/nutrition supplementation, folic acid consumption, genetic testing, and HIV treatment. Third, there has been a further expansion of prenatal care psychosocial content to address newer and possibly more potent health risk factors, such as spousal violence and environmental risks. Finally, there has been a refocusing of prenatal care to once again address issues of maternal health and to not simply focus on birth outcomes (i.e., examining the impact of pregnancy on women's health, not simply the impact of women's health on pregnancy outcomes). Such an orientation focuses on prenatal to postnatal continuities in maternal depression, obesity, hypertension, and diabetes, as well as postpartum linkage to health services and satisfaction with care.

Beyond attempting to reduce the number of infants born small and premature, U.S. public health and clinical efforts to improve prenatal care usage and content have not generally been directly linked to child development programs. The federal funding sources that address these two developmental periods have been generally quite distinct. The temporal focus of some of the relevant professions has not generally overlapped, which further adds to their discontinuity. For example, obstetricians and public health maternity workers may have little interaction with pediatricians.

There are, however, increasing areas of overlap between prenatal care and child development efforts. There is increased recognition that many of the same high-risk families are being seen in both public prenatal care and child development programs. Maternal well-being (both physical and psychosocial) is critical in both the prenatal and postnatal periods. Comprehensive prenatal care now includes many of the same interventions as child development: home visitation, parent education, etc. In turn, the child development community is increasingly recognizing the importance of prenatal factors (including prenatal care) on subsequent infant and child functioning. There is a growing number of federal programs that try to improve both the reproductive and child developmental domains, including Medicaid, WIC, Early Intervention, and Title V. The newly revised Healthy Start program (the largest federal initiative dedicated to reproductive health) also has a focus on maternal and infant health from pregnancy through the first two years of an infant's life.

Prenatal care remains primary care for women in pregnancy. Its impact on both maternal health and newborn health reflects the evolving knowledge about its content and society's ability to ensure universal access.