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Preconception and Pregnancy
Knowledge Path

Introduction

This knowledge path about preconception and pregnancy has been compiled by the Maternal and Child Health Library at Georgetown University. It offers a selection of current, high-quality resources that analyze perinatal health statistics, describe effective prenatal care programs, and report on research aimed at improving access to and quality of prenatal care and improving perinatal health outcomes. A separate section lists consumer health resources. The final part of the knowledge path presents resources on specific aspects of preconception and pregnancy: childbirth, depression, drug and alcohol use, environmental concerns, fertility and infertility, nutrition, oral health, and tobacco use. This knowledge path will be updated periodically.

Related topics: Please see our knowledge paths about adolescent pregnancy prevention, community services locator, depression during and after pregnancy, infant mortality and pregnancy loss, and oral health for infants, children, adolescents, and pregnant women. Also see the resource brief about home visiting.

Resources for Professionals

Web Sites: A-Z

• Agency for Healthcare Research and Quality (AHRQ): Women's Health. Provides clinical information about maternal health and pregnancy. Presents data from the Healthcare Cost and Utilization Project (HCUP), National Guideline Clearinghouse, and National Quality Measures Clearinghouse™ (NQMC). AHRQ is the health services research arm of the Department of Health and Human Services (DHHS). Recent publications include

  Gestational diabetes: Caring for women during and after pregnancy. (2009). [Clinician's guide].

  Health care expenditures for uncomplicated pregnancies. (2007).

  Primary care interventions to promote breastfeeding. (2008).

  Screening for bacterial vaginosis in pregnancy. (2008).

  Screening for Human Immunodeficiency Virus infection, rev. ed. (2007).

• American College of Obstetricians and Gynecologists (ACOG). Contains brochures, booklets, policy statements, and other materials about preconception and pregnancy for health professionals. Topics include health care for underserved women, perinatal HIV, smoking cessation, and women with disabilities. Also presents an online directory of physicians. Note: Many resources on the site are accessible to members only.
  
  
• Association of Maternal and Child Health Programs (AMCHP): Women's Health. Offers information and resources, including slide presentations, fact sheets, and training programs to help states build their capacity to provide essential women's health services. Project areas include health disparities; healthy weight; infant mortality; perinatal HIV prevention; reducing maternal illness, injury, and death; tobacco use prevention and cessation; and other emerging issues. Recent publications include

  HIV testing in pregnant women. (2006).

  Perinatal HIV action learning lab: Summary report. (2006).

  Preconception health and health care. (2007).

  Promoting healthy weight among women of reproductive age. (2006).

• Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). Offers clinical practice information and continuing-education resources about preconception, pregnancy, labor and delivery management, and postpartum care.
  
  
• Centers for Disease Control and Prevention (CDC). Contains information about preconception and pregnancy. Resources and initiatives include

  CDC's Division of Reproductive Health. Contains links to reports, data, and other resources about pregnancy and prenatal care, including maternal morbidity and mortality; smoking; alcohol use; folic acid consumption; violence; workplace hazards; and racial and ethnic disparities.

  CDC's Morbidity & Mortality Weekly Reports (MMWR). Presents data based on weekly reports to CDC by state health departments. Also offers online continuing-education courses for health professionals that coincide with several preconception and pregnancy-related guidelines published in MMWR. Recent reports about preconception and pregnancy include

  • Achievements in public health: Reduction in perinatal transmission of HIV infection -- United States, 1985-2005. (2006).
    
    
  • Monitoring progress toward achieving maternal and infant Healthy People 2010 objectives --19 states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003. (2006).
    
    
  • Perinatal Group B Streptococcal Disease after universal screening recommendations --United States, 2003-2005. (2007).
    
    
  • Recommendations to improve preconception health and health care -- United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. (2006).
    
    
  • Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. (2006).
    
    
  • Surveillance of preconception health indicators among women delivering live-born infants -- Oklahoma, 2000-2003. (2007).

  CDC's National Center for Health Statistics (NCHS). Provides data about preconception and pregnancy, including

  • Births: Preliminary data for 2005. (2006).
    
    
  • Estimated pregnancy rates by outcome for the United States, 1990-2004. (2008).
    
    
  • Maternal mortality and related concepts. (2007).
    
    
  • Prenatal care: FASTATS A to Z. (2007).
    
    
  • Also see NCHS's Data2010, and Health Data for All Ages.

  CDC's National Center on Birth Defects and Developmental Disabilities (NCBDDD). Offers scientific publications and tools, guidelines, educational materials, an electronic discussion group, and information about research projects and public health campaigns to identify the causes of birth defects. Preconception and pregnancy-related topics include folic acid consumption, preventing alcohol-exposed pregnancies, medication use during pregnancy, and using family history information in obstetrics and pediatrics.

  Other resources and initiatives about preconception and pregnancy from CDC:

  Critical needs in caring for pregnant women during times of disaster for non-obstetric health care providers. (2007).

  Guidelines for vaccinating pregnant women, rev. ed. (2007).

  Guide to Community Preventive Services. Contains information about a systematic review of studies to develop recommendations for reducing the number of pregnancies affected by neural tube defects.

  One Test, Two Lives. Provides resources for health professionals and materials for their patients to help encourage universal voluntary prenatal testing for HIV.

  Also see CDC's Pregnancy Risk Assessment Monitoring System (PRAMS), Pregnancy Surveillance System (PNSS), and VitalStats.

• Centers for Medicare and Medicaid Services (CMS). Contains program information, eligibility criteria, publications, forms, and data about Medicaid, which offers coverage for eligible pregnant women. CMS administers Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP).
  
  
• CityMatCH. Contains tools and resources for implementing the Perinatal Periods of Risk (PPOR) approach for mobilizing urban communities to reduce feto-infant mortality in U.S. cities. Also presents publications about perinatal HIV prevention in urban communities.
  
  
• Healthy People 2010. Offers information about this national health-promotion and disease-prevention initiative. It is coordinated by the Office of Disease Prevention and Health Promotion (ODPHP). Healthy People contains 467 objectives, and 31 focus on pregnancy. To identify them, search the objectives by selecting pregnancy under Topic. Click on Submit. See Data2010 for data about the Healthy People 2010 pregnancy objectives and the HP2010 Information Access Project for access to published literature related to the Healthy People 2010 objectives about pregnancy and family planning. Also view proposed Healthy People 2020 objectives for family planning and maternal, infant, and child health.
  
  
• Kaiser Family Foundation (KFF): Women's Health Policy. Provides fact sheets, issue briefs, meeting materials, data, and news for policymakers, journalists, advocates, and public health professionals about women's reproductive health and access to care, including pregnancy-related care. KFF is an independent philanthropy focusing on national health care issues. Recent publications include

  Maternity care and consumer-driven health plans. (2007).

  Medicaid's role for women. (2007).

• March of Dimes (MOD). Offers perinatal statistics, continuing-education modules, and medical reference information on topics that include preconception, pregnancy, prenatal screening, and genetics. Recent publications include

  Costs of maternity and infant care. (2007).

  Diabetes in pregnancy. (2006).

  Healthcare costs of having a baby. (2007).

  HIV and AIDS in pregnancy. (2006).

• Maternal and Child Health Bureau (MCHB). Describes MCHB's projects and initiatives on behalf of America's women, infants, children, adolescents, and their families. Programs include the Title V block grant to states (see the Title V Information System for state and federal budget and expenditure data on prenatal care and information about states' efforts to improve pregnancy outcomes). MCHB has a fact sheet about prenatal care in English and Spanish that includes a hotline number to help pregnant women find prenatal care services in their communities. The Maternal and Child Health Library and the Discretionary Grant Information System (DGIS)offer additional information about the initiatives and programs supported by MCHB that pertain to prenatal care. MCHB is part of the Health Resources and Services Administration (HRSA). Another recent resource is

  Women's health USA. (2007). This data book presents key facts and figures about U.S. women. It includes information about population characteristics, health status, and health services utilization. Topics include maternal health.

• National Birth Defects Prevention Network (NBDPN). Presents a collection of materials to assist state program administrators and health professionals in promoting birth defects prevention. Each year, NBDPN selects a different theme to highlight, and the 2009 theme is obesity prevention and weight management before, during, and after pregnancy. Preventing infections in pregnancy, preconceptional health, fetal alcohol spectrum disorders, cardiac defects, neural tube defects, and cleft lip and cleft palate are themes for earlier years for which there are materials.
  
  
• National Healthy Start Association (NHSA). Describes the Healthy Start program and provides general information about infant mortality, low-birthweight infants, and racial disparities in perinatal outcomes. Includes a directory of Healthy Start programs nationwide and a newsletter. Funded by the Maternal and Child Health Bureau (MCHB), Healthy Start provides community-based, culturally competent, family-centered, comprehensive perinatal health services to women, infants, and their families in communities with very high rates of infant mortality. See the Discretionary Grant Information System (DGIS)for information about Healthy Start grantees. Also see the Maternal and Child Health Library's Healthy Start Collection Database for a catalog of materials developed by Healthy Start programs.
  
  
• National Institute of Child Health and Human Development (NICHD): Women's Health Research. Contains research and grant information, publications, and other resources on topics that include preconception and prenatal care, miscarriage and stillbirth, preterm labor and premature birth, disorders of pregnancy, drug safety in pregnant women, and reproductive health among women with physical disabilities. NICHD is part of the National Institutes of Health (NIH). Recent publications include

  State-of-the-Science Conference on cesarean delivery on maternal request. (2006). A news release, Webcast, program and abstract booklet, and literature review accompany the consensus statement.

• National Perinatal Association (NPA). Offers a collection of position papers about access to perinatal care, breastfeeding, domestic violence, medical liability reform, substance abuse in pregnancy, and transcultural perinatal care. Also offers information about NPA's resource guide and training program about transcultural perinatal care.
  
  
• National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center. Includes resources about stillbirth and miscarriage for health professionals, policymakers, and families. The resource center and the Maternal and Child Health (MCH) Library are co-located at Georgetown University's National Center for Education in Maternal and Child Health and are supported with funding from the Maternal and Child Health Bureau (MCHB).
  
  
• UNC Center for Maternal and Infant Health. Presents preconception and pregnancy research and program information, algorithms for the management of high-risk pregnancies, a family history questionnaire, and information about cystic fibrosis, maternal age and pregnancy, prenatal screening, and prenatal diagnosis. Offers patient-education fact sheets in English and Spanish on pregnancy topics, genetics, and serious pregnancy and fetal conditions. The Center is part of the University of North Carolina at Chapel Hill School of Medicine. Reports include

  Looking back, moving forward: North Carolina's path to healthier women and babies. (2007). Meeting materials and an executive summary accompany the report.

• World Health Organization (WHO): Partnership for Maternal, Newborn, and Child Health. Offers program information and resources in English and five other languages about pregnancy, childbirth, maternal mortality, and infant and child mortality worldwide. Fact sheets, press materials, an advocacy kit, presentations, and reports are among the resources presented.
  

  
  

Additional Electronic Publications

• Behrman RE, Butler AS, eds. 2007. Preterm birth causes, consequences, and prevention. Washington, DC: National Academies Press. This report notes troubling disparities in preterm birth rates among different racial and ethnic groups. The report recommends a multidisciplinary research agenda aimed at improving (1) the ability to predict whether a woman is at risk for preterm labor, (2) the ability to prevent preterm labor, and (3) the understanding of the health and developmental problems to which preterm infants are vulnerable.
  
  
• Campbell KP, ed. 2007. Investing in maternal and child health: An employer's toolkit. Washington, DC: National Business Group on Health. This toolkit provides employers with information to design health-promoting and cost-effective medical benefits for children, adolescents, and pregnant women.
  
  
• Guyer B, Ma S, Grason H, Frick K, Perry D, Wigton A, McIntosh J. 2008. Investments to promote children's health: A systematic literature review and economic analysis of interventions in the preschool period. Washington, DC: Partnership for America's Economic Success. This report examines the short- and long-term impacts of health-promotion and disease-prevention interventions on selected health problems in infants and young children from birth to age 5. The report reviews the patterns and monetary burden of poor child health, the cost implications of preventing and treating child health problems, and cost-benefit analyses related to the interventions. Summaries of studies of interventions during pregnancy that report child health and economic outcomes are included. Information on cost-benefit analyses for interventions on tobacco use, obesity, unintentional injury, and mental health problems is provided. Also see the research brief, Early childhood health problems and prevention strategies: Costs and benefits (2008).
  
  
• Institute of Medicine (IOM). 2009. Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: Institute of Medicine. This report examines weight gain during pregnancy and uses prepregnancy weight and body mass index to set a range for healthy weight gain. It makes recommendations to federal, state, and local organizations about using these updated guidelines to move women toward healthier pregnancies.
  
  
• Isaacs JB. 2007. Cost-effective investments in children. Washington, DC: Brookings Institution. This paper identifies four areas of investment in children where there is sufficient evidence of positive outcomes and sound benefit-cost ratios to merit expanded federal funding. Target areas are early-childhood-education programs, home-visiting programs to promote sound prenatal care and the healthy development of infants and young children, school reform, and programs that reduce the incidence of adolescent pregnancy.
  
  
• Ku L. 2007. Reducing disparities in health coverage for legal immigrant children and pregnant women, rev. ed. Washington, DC: Center on Budget and Policy Priorities (CBPP). This fact sheet provides information about reducing disparities in health coverage for legal immigrant children and pregnant women. The fact sheet examines the current health coverage of legal immigrants and opportunities to restore equity to legal immigrant children and pregnant women.
  
  
• Moiduddin E, Massey D. 2006. Segregation, the concentration of poverty, and birth weight. Princeton, NJ: Center for Research on Child Wellbeing. This paper examines the relationship between neighborhood conditions experienced by pregnant women of various racial and ethnic groups and the weights of the infants they ultimately deliver, controlling for individual and family characteristics.
  
  
• Thomson Healthcare. 2007. Healthcare costs of having a baby. Santa Barbara, CA: Thomson Healthcare. This report quantifies the overall costs of health care services for having a baby, including all prenatal care services, delivery-related services, and postpartum services for the mother.
  

  
  

Databases

The databases listed below are excellent tools for identifying data, additional literature and research, and programs about preconception and pregnancy. Many of the entries below contain tips on how to use the databases efficiently. Please note that databases vary in how terms should be entered; for example, some require quotation marks and others don't. Enter search phrases as shown in bold below.

Data

• Child Trends DataBank. Reports on national trends and research on over 80 key indicators of child and adolescent well-being and offers information about the types of programs and interventions that may influence particular outcomes. Child Trends is a nonprofit, nonpartisan research organization providing research and data to inform decision-making that affects children and adolescents. Recent analyses about pregnancy and prenatal care include

  Conceptualizing a "strong start": Antecedents of positive child outcomes at birth and into early childhood. (2007).

  Men's pregnancy intentions and prenatal behaviors: What they mean for fathers' involvement with their children. (2007).

• Data2010: The Healthy People 2010 Database. Contains the most recent monitoring data for tracking Healthy People 2010. To obtain data on the topic, click on the field, Data by Focus Area. Under the field, Select a Focus Area, choose 16 - Maternal, Infant, and Child Health from the pop-up menu. Next, click on the button for Include Related Objectives From Other Focus Areas in the Table. Click on the Submit button. Scan the report to identify data about the many objectives related to preconception and pregnancy. This data set is provided by the National Center for Health Statistics (NCHS) via CDC Wonder.
  
  
• Discretionary Grant Information System (DGIS). Contains financial, national performance measure, and abstract data collected annually from more than 900 grants issued by the Maternal and Child Health Bureau (MCHB), including data from grants to improve pregnancy outcomes.
  
  
• Healthcare Cost and Utilization Project (HCUP): HCUPnet. Provides access to health statistics and information on hospital inpatient and emergency department utilization at the national, regional, and state levels. To identify data about hospital use related to pregnancy and childbirth, select National Statistics on All Stays or State Statistics on All Stays. Select Researcher, medical professional. Under type of query, select Statistics on specific diagnoses or procedures. Select a year (e.g., 2005). Select Diagnoses grouped by Clinical Classifications Software (CCS). Select Principal diagnosis. Under the field, Browse all CCS categories, scroll to 11 Complications of Pregnancy, Childbirth, and the Puerperium. Highlight the category of interest (e.g., Normal pregnancy and/or delivery). Hold the control key down and click to make multiple selections. Click on Next. Select the outcomes and measures of interest (e.g., Number of discharges) and click on Next. Select patient and hospital characteristics (e.g., All patients in all hospitals) and click on Next. View your results. HCUP is an initiative of the Agency for Healthcare Research and Quality (AHRQ). HCUP statistical briefs include

  Hospitalizations related to childbirth, 2003. (2006).

• Health Data for All Ages. Presents interactive online data tables on pregnancy and birth, health conditions and risk factors, health care access and use, and mortality. Prenatal care data is presented by maternal age, race/ethnicity, prenatal care timing (i.e., first trimester, late, or none), state, and for the United States overall. This data warehouse is a service of the National Center for Health Statistics (NCHS).
  
  
• National Center for Health Statistics (NCHS): VitalStats. Presents interactive maps and tables for over 100 public-use birth variables such as low birthweight, gestation, pregnancy-associated risk factors, and cesarean deliveries.
  
  
• National Quality Measures Clearinghouse™ (NQMC). Contains evidence-based health care quality measures and measure sets for physicians, hospitals, and health plans to evaluate and improve the quality of health care for consumers. Identify measures on the topic by entering pregnancy in the search box. Click on Search to get your results. The database is sponsored by the Agency for Healthcare Research and Quality (AHRQ).
  
  
• Office on Women's Health (OWH) Quick Health Data Online. Offers comparative, county-level health data for all 50 states, the District of Columbia, and U.S. territories and possessions. County, state, regional and national data are available and can be accessed by gender, race/ethnicity, and age, concurrently. Maternal health is a category.
  
  
• PeriStats. Provides access to maternal- and infant-health-related data at the national, state, county, and city levels. Topics include the timing and adequacy of prenatal care, tobacco use, childbirth method, preterm birth, infant mortality, and health insurance coverage. Over 60,000 graphs, maps, and tables are available. PeriStats is a service of the March of Dimes Perinatal Data Center.
  
  
• Pregnancy Risk Assessment Monitoring System (PRAMS). Presents state-specific, population-based data on maternal attitudes and experiences before, during, and immediately following pregnancy. PRAMS is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. Recent reports are available via CDC's Division of Reproductive Health.
  
  
• State Health Facts Online. Contains state-level data on women's health-related Medicaid information, enrollment practices, state insurance mandates, and refusal clauses. Includes data about contraception, infertility diagnosis and treatment, prenatal care, and health care access. Information can be displayed as tables, graphs, or color-coded maps. This database is a service of the Kaiser Family Foundation (KFF).
  
  
• Title V Information System (Title V IS). Contains data from annual Title V Block Grant applications and reports submitted by all 59 U.S. states and jurisdictions. To learn about states' efforts to improve pregnancy outcomes, conduct several searches. Select Financial Data to view state and federal budget and expenditure data on prenatal care for pregnant women. Under Program Data, find the number of pregnant women served by Title V, health screening and treatment information by states, Medicaid/non-Medicaid comparison of prenatal care services, and eligibility criteria for pregnant women for Medicaid and SCHIP. Also view Measurement and Indicator Data to learn about states' efforts to address a core set of performance and outcome measures that include services for pregnant women. Title V IS is a service of the Maternal and Child Health Bureau (MCHB). Also see MCHB's Discretionary Grant Information System (DGIS).
  
  
• Also see the Morbidity & Mortality Weekly Reports (MMWR), the National Center for Health Statistics (NCHS), the Pregnancy Surveillance System (PNSS), and Women's health USA (2006).  
  

Literature and Research Databases

• Clinical Evidence. Describes the best available evidence from systematic reviews of the literature about the prevention and treatment of clinical conditions. Topics include pregnancy and childbirth. Clinical Evidence is available by subscription only from the BMJ Publishing Group Limited, located in the United Kingdom.
  
  
• Cochrane Database of Systematic Reviews. Presents systematic reviews of the effects of health care interventions internationally. Provides access to abstracts that can be browsed by title or by topic such as pregnancy and childbirth. Access to the full-text article requires a subscription. The database is published by the Cochrane Collaboration, an international not-for-profit organization based in the United Kingdom.
  
  
• Database of Abstracts of Reviews of Effects (DARE). Contains summaries of systematic reviews that have met strict quality criteria. Included reviews have to be about the effects of interventions. Each summary also provides a critical commentary on the quality of the review. The database covers a broad range of health topics, including pregnancy. To identify summaries on the topic, type preconception pregnancy in the search box, and click on Any of these words. Click on Search to get your results. DARE is produced and maintained by the Centre for Reviews and Dissemination at the University of York.
  
  
• HP2010 Information Access Project (HP2010 IAC). Provides an automatic search mechanism for published literature indexed in PubMed related to the Healthy People 2010 objectives about maternal, infant, and child health and family planning. Also links to a narrative for each objective and the complete chapters about maternal, infant, and child health and family planning in the text, Healthy People 2010: Understanding and improving health, 2nd ed. (2000). This service is provided by the Partners in Information Access for the Public Health Workforce, a collaboration of federal agencies, public health organizations, and health sciences libraries.
  
  
• Maternal and Child Health Library at the National Center for Education in Maternal and Child Health (NCEMCH), Georgetown University. Maintains several databases to collect, manage, and disseminate knowledge about maternal and child health, with special emphasis on knowledge gained from initiatives and programs supported by the Maternal and Child Health Bureau (MCHB). The library's bibliographic databases are

  Healthy Start Collection Database. Comprises an online catalog of over 2,000 items developed by Healthy Start sites, including brochures, bylaws, curricula, marketing materials, policies, and national evaluation reports along with other material related to maternal and infant health. Materials are classified according to the nine Healthy Start models of intervention that range from community-based consortia to risk prevention and reduction. Search the database using the term prenatal, and narrow your search by selecting a model of intervention, project name, or additional terms.

  MCHLine®. Comprises an online catalog of materials in the Maternal and Child Health Library. Pregnancy-related bibliographies include Adolescent prenatal care, AIDS/HIV in pregnancy, Home visiting, Nutrition during pregnancy, Prematurity, Prenatal care, Smoking during pregnancy, and Substance use during pregnancy.

  The Maternal and Child Health Library also offers organizations and programs databases.

• National Guideline Clearinghouse (NGC). Contains evidence-based clinical practice guidelines and related materials for health professionals. Identify guidelines on the topic by entering preconception OR prenatal in the search box. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ).
  
  
• PubMed. Contains more than 19 million citations for biomedical articles from MEDLINE and life science journals. Citations may include links to full-text articles from PubMed Central or publisher web sites. To identify citations on the topic, enter preconception care OR prenatal care OR pregnancy in the search box. Click on Limits and make the following selections on the page: select a date (e.g. Published in the last 2 years); click on Languages: English; Click on Species: Humans; and select Search Field Tags: MeSH Major Topic. Click on Search to get your results. To narrow your search further or for additional searches, use the MeSH (Medical Subject Headings) database to identify terms (e.g., (preconception care OR prenatal care OR pregnancy) AND diabetes. PubMed is a service of the National Library of Medicine (NLM).
  
  
• Society of Obstetricians and Gynaecologists of Canada: Clinical Practice Guidelines. Offers clinical practice guidelines published in the peer-reviewed journal, Journal of Obstetrics and Gynaecology of Canada. Select a pregnancy topic to link to all available guidelines on that topic.
  
  
• Also see the Household Products Database and the Food and Nutrition Information Center (FNIC) Databases.
  

Programs Databases

• Health Services Research Projects in Progress (HSRProj). Provides information about ongoing health services research and public health projects. To identify projects on the topic, enter the search phrase preconception OR pregnancy. Click on Search to get your results. HSRProj is funded by the National Library of Medicine (NLM).
  
  
• Maternal and Child Health Library at the National Center for Education in Maternal and Child Health (NCEMCH), Georgetown University. Maintains two databases to identify pregnancy-related organizations and programs:

  MCH Organizations Database. Lists over 2,000 government, professional, and voluntary organizations involved in MCH activities, primarily at a national level. Several national organizations offer information about pregnancy and prenatal care, and these appear in a list produced from the database.

  MCH Projects Database. Comprises an online catalog of projects funded by the Maternal and Child Health Bureau (MCHB). To identify projects that focus on the topic, type prenatal in the abstract field of the database search form. Conduct additional separate searches using the terms preconception, pregnant, and perinatal. Final reports are available from several of these projects. Also see MCHB's Discretionary Grant Information System (DGIS).

  
  

Electronic Newsletters and Online Discussion Group

• Getting Off to a Healthy Start. This newsletter, published quarterly by the National Healthy Start Association (NHSA), informs Healthy Start staff and others in the MCH community about successful community-based approaches to reducing infant mortality and improving perinatal outcomes. The newsletter also highlights research and evaluation findings, legislative activities, and conference announcements.
  
  
• Kaiser Daily Women's Health Policy Report. This electronic newsletter provides legislative, political, legal, scientific, and business news on women's health policy issues that include pregnancy and childbirth.
  
  
• National Birth Defects Prevention Network Listserv. This electronic discussion group aims to enhance communication among public health professionals working at the state level in birth defects surveillance and prevention. This group is administered by the Centers for Disease Control and Prevention (CDC).
  
  
• Text4baby Tuesday. This weekly electronic newsletter presents information about Text4baby, which offers free weekly messages by cell phone to help pregnant women and new parents through pregnancy and their baby's first year. Signup for Text4baby Tuesday to receive news from the national campaign and get program updates on partners' innovative promotion across the country. Text4baby is an educational program of the National Healthy Mothers, Healthy Babies Coalition.
  

  
  

Resources for Families

• See the Maternal and Child Health Library's family resource brief, Preconception and Pregnancy.
  

  
  

Resources on Specific Aspects of Preconception and Pregnancy

Childbirth
Depression
Drug and Alcohol Use
Environmental Concerns
Fertility and Infertility
Genetics
Nutrition
Oral Health
Tobacco Use

Childbirth

• American College of Nurse-Midwives (ACNM). Includes position statements, clinical bulletins, state fact sheets, continuing-education tools, and other resources about maternal and infant health and midwifery. Also presents a national directory of midwifery practices.
  
  
• Childbirth Connection. Provides evidence-based resources about childbirth education, childbirth setting, labor support, and perinatal care. The Childbirth Connection promotes safe, effective, and satisfying evidence-based maternity care. Resources include

  Evidence based maternity care: What it is and what it can achieve. (2008).

  Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. (2006).

• Choices in Childbirth. Presents surveys, statistics, reports, and guides about the range of choices available to women for maternity care and birth experiences.
  
  
• Coalition for Improving Maternity Services (CIMS). Presents the evidence-based Mother-Friendly Childbirth Initiative guidelines for identifying and designating "mother-friendly" birth sites including hospitals, birth centers, and home-birth services. The initiative outlines 10 steps for mother-friendly care and includes a guide for consumers. CIMS is a collaborative effort of numerous individuals and more than 50 organizations with a mission to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.
  
  
• International Childbirth Education Association (ICEA). Offers information about certification programs for childbirth educators, including postnatal educators, doulas, and perinatal fitness educators. Includes an order form for position papers, books, teaching aids, and other materials.
  
  
• Lamaze International. Offers research summaries, teaching tools, conference information, position papers, and other materials for childbirth educators and health professionals. Also offers resources about pregnancy and childbirth and information about Lamaze classes for expectant parents. Recent publications include

  Lamaze Institute for Normal Birth care practice papers, rev. ed. (2007). This set of six papers is available in English, Spanish, Russian, and Mandarin.

• Also see the American College of Obstetricians and Gynecologists (ACOG), CDC's QuickStats: Percentage of births attended by midwives -- United States, 2003 (2006), CDC's Rates of cesarean delivery among Puerto Rican women -- Puerto Rico and the U.S. mainland, 1992-2002 (2006) and the NICHD report, State-of-the-Science Conference on cesarean delivery on maternal request (2006).
  

  
  

Depression

• See the Maternal and Child Health Library's knowledge path, Depression during and after pregnancy.
  

  
  

Drug and Alcohol Use

• Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence. Presents a wealth of program information and resources for health professionals, policymakers, and consumers about preventing and treating FASD. Includes fact sheets, brochures, posters, Spanish-language materials, curricula, proceedings, reports, and videotapes. The center is part of the Substance Abuse and Mental Health Services Administration (SAMHSA).
  
  
• Kim J, Krall J. 2006. Literature review: Effects of prenatal substance exposure on infant and early childhood outcomes. Berkeley, CA: National Abandoned Infants Assistance Resource Center. This report highlights recent findings from academic literature concerning the debate about the consequences of prenatal substance exposure on infants and children.
  
  
• National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2006. Drinking and your pregnancy, rev. ed. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism (NIAAA). This brochure for pregnant women explains the dangers of drinking alcohol while pregnant.
  
  
• National Organization on Fetal Alcohol Syndrome (NOFAS). Contains program information and resources for pregnant women, health professionals, and educators about the dangers of alcohol consumption during pregnancy. Links to contact information for addiction treatment centers. NOFAS is dedicated to eliminating birth defects caused by alcohol consumption during pregnancy and to improving the quality of life for affected individuals and families.
  
  
• Office of the Surgeon General. 2005. Advisory on alcohol use in pregnancy. Rockville, MD: Office of the Surgeon General. This advisory and press release urge women who are pregnant or who may become pregnant to abstain from consuming alcohol. The advisory includes background information; research findings on fetal alcohol syndrome, prenatal alcohol exposure, and alcohol-related birth defects; and the Surgeon General's recommendations for women and health professionals.
  
  
• See MedlinePlus: Pregnancy and substance abuse.
  
  
• See ACOG's tool, Drinking and reproductive health: A fetal alcohol spectrum disorders prevention tool kit for women's health clinicians (2006).
  
  
• See the MCH Library's organizations resource list, Substance use.
  
  
• Also see CDC's National Center on Birth Defects and Developmental Disabilities (NCBDDD), the National Perinatal Association (NPA), PeriStats, the Pregnancy Risk Assessment Monitoring System (PRAMS), the Maternal and Child Health Library, Motherisk, and the Organization of Teratology Information Specialists (OTIS).
  

  
  

Environmental Concerns

• Allsopp M, Santillo D, Kallee U, Hosjsik M. 2006. Fragile: Our reproductive health and chemical exposure. A review of the evidence for links between declines in human reproductive health and our exposure to hazardous chemicals. Amsterdam, The Netherlands: Greenpeace International.
  
  
• Household Products Database. Links information for over 6,000 consumer brands to health effects from Material Safety Data Sheets (MSDS) provided by consumer-product manufacturers. Researchers and consumers can search by product, chemical ingredient, or health effects as listed in the MSDS, including fertility and pregnancy. This database is a service of the National Library of Medicine (NLM).
  
  
• Motherisk. Provides evidence-based information for consumers and health professionals about the safety or risk of drugs, herbs, chemical exposures, and disease during preconception, pregnancy, and breastfeeding. Also offers information about current clinical and laboratory research being conducted by Motherisk, a service of the Hospital for Sick Children in Toronto, Canada.
  
  
• National Children's Study. Contains information about this study to examine the effects of environmental influences on the health and development of more than 100,000 children and adolescents across the United States, following them from before birth until age 21. As part of the study, the Fertility and Early Pregnancy Working Group is exploring the link between a child's health and the parent's fertility experience as well as parental exposures before and/or in early pregnancy (often before a woman knows she is pregnant). The Pregnancy and the Infant Working Group is evaluating the association of environmental exposures during mid- and late pregnancy with pregnancy outcomes and child health and development. The National Institute of Child Health and Human Development (NICHD) and a consortium of federal agencies are conducting the study.
  
  
• National Institute of Environmental Health Sciences (NIEHS): Reproductive Health. Presents information about health studies and clinical trials on the effects of environmental contaminants on reproductive outcomes.
  
  
• National Toxicology Program: Center for the Evaluation of Risks to Human Reproduction (NTP-CERHR). Offers a monograph series, expert panel reports, and public comments about potentially hazardous effects of chemicals on human reproduction and development. Also links to information on common concerns about and exposures to substances and their effect on fertility, pregnancy, and the health of unborn children. NTP-CERHR is part of the National Institute of Environmental Health Sciences (NIEHS).
  
  
• Organization of Teratology Information Specialists (OTIS). Offers a national toll-free telephone number for questions regarding exposures to medications, herbal products, infections and vaccines, maternal medical conditions, illicit substances, and other common exposures during pregnancy. Telephone: (866) 626-OTIS (6847). Also presents a collection of fact sheets to answer frequently asked questions about exposures during pregnancy.
  
  
• See MyPyramid for Pregnancy and Breastfeeding and the report Food safety: Eating fish while you are pregnant or breastfeeding (2007).
  
  
• See MedlinePlus: Environmental Health.
  

  
  

Fertility and Infertility

• American Society for Reproductive Medicine (ASRM). Offers a wealth of resources for consumers and professionals about infertility, menopause, contraception, and sexuality. Includes a collection of resources about preventing infertility. Also offers contact information for ASRM member physicians, endocrinologists, surgeons, assisted reproductive technology clinics, and specialists in male reproduction and urology.
  
  
• RESOLVE: The National Infertility Association. Offers information for people experiencing infertility. Topics include treatment, diagnosis, coping, adoption, and the costs of infertility treatment. Also lists telephone helplines for local and regional chapters and affiliates in the United States.
  
  
• See the Maternal and Child Health Library's guide, Assisted Reproductive Technologies (ART) and families: Selected resources, which presents resources about the psychological and social impacts of ART on children conceived via ART and on their families. The list also provides resources related to ethical and legal issues associated with ART.
  
  
• See MedlinePlus: Reproductive health and MedlinePlus: Infertility.
  
  
• See the CDC's reports, Assisted reproductive technology success rates: National summary and fertility clinic reports (2006), Assisted reproductive technology surveillance -- United States, 2006 (2009), and Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth (2005).
  
  
• See the Mothers of Supertwins (MOST) statement, Recommendations for the responsible use of fertility treatments to reduce the number of high-risk multiple birth pregnancies (2007).
  
  
• Also see Our Bodies Ourselves Health Resource Center.
  

  
  

Genetics

• American College of Medical Genetics (ACMG). Offers practice guidelines, policy statements, and other resources on topics such as prenatal diagnosis and newborn screening. Recent resources include

  Intermediate management guides for newborn screening. (2006).

  Newborn screening: Toward a uniform screening panel and system. (2006).

• Genetic Alliance. Contains family history tools, resources about genetic conditions, and information on public policy issues such as a national newborn screening policy, genetic testing, and open access to federally funded genetic research. The Genetic Alliance is a coalition of genetic advocacy organizations, health professionals, clinics, hospitals, and companies that promotes the needs of individuals affected by genetic disorders and their families.
  
  
• Genetics Home Reference. Presents information about the effects of genetic variations on human health. Learn about genes, chromosomes, genetic conditions, genetic counseling, genetic testing, and genomic research. Includes information and links to additional resources about newborn screening. This Web site is a service of the National Library of Medicine (NLM).
  
  
• March of Dimes (MOD): Genetics. Offers continuing-education modules about genetic testing and screening, family health and social history, and referral to genetic services. Lists resources for professionals and families on topics that include genetic counseling, preconception and prenatal genetic screening, newborn screening, and birth defects and genetic conditions. Recent publications include

  Making community partnerships work: A toolkit. (2007).

  Newborn screening tests. (2008).

• National Newborn Screening and Genetics Resource Center (NNSGRC). Presents information and links to resources about newborn screening and genetics for health professionals, families, and policymakers. Includes contact information for state newborn screening and genetics programs and commercial and non-profit organizations offering expanded newborn screening tests. Also presents a list of hearing screening resources. NNSGRC is located at the University of Texas Health Science Center at San Antonio. Recent publications include

  National newborn screening status report, rev. ed. (2008).

• See the MedlinePlus resources about genetic counseling, genetic testing, prenatal testing, and newborn screening. Also see the American College of Obstetricians and Gynecologists (ACOG) pamphlet, Special tests for monitoring fetal health (2009).
  
  
• Also see the Maternal and Child Health Library's resource brief, Genetics, and the screening section of the knowledge path, Children and youth with special health care needs.
  

  
  

Nutrition

• Folicacid.net. Contains a Web-based training module for health professionals and a collection of resources for professionals and consumers about folic acid. This site was developed by the Association of Schools of Public Health (ASPH) and the March of Dimes (MOD).
  
  
• Food and Nutrition Information Center (FNIC): Pregnancy. Presents resource lists with links to sources of information about nutrition in pregnancy. Offers an extensive collection of reports and studies about the Supplemental Nutrition Program for Women, Infants, and Children (WIC). FNIC is part of the U.S. Department of Agriculture (USDA). Resources include
  
  Food and Nutrition Information Center (FNIC) Databases. Contains information about evaluated food and nutrition education and training materials, research reports, and other resources for nutrition educators and other health professionals, school food service and child nutrition personnel, and families, including pregnant women. Database topics related to prenatal care include food safety, nutrition for pregnant women, nutrition education for Native Americans, food stamps, and dietary supplements.
  
  
• Griffen A. 2006. ABCs of folic acid counseling. Washington, DC: Spina Bifida Association. This continuing-education tutorial offers guidance for health professionals on how to conduct a 1-minute folic acid counseling session during an interaction with a woman, how to identify women at risk for recurrence of spina bifida or another neural tube defect, and how to prepare evaluation plans for folic acid counseling.
  
  
• Joyce T, Racine AD, Yunzal-Butler C. 2007. Reassessing the WIC effect: Evidence from the Pregnancy Nutrition Surveillance System. Cambridge, MA: National Bureau of Economic Research (NBER). This report describes the results of a study that tested whether exposure to the WIC program is associated with less smoking and improved weight gain during pregnancy, better birth outcomes, and greater likelihood of breastfeeding.
  
  
• Leadership, Education and Training (LET) Program in Maternal and Child Nutrition. Contains Web-based curricula and training information about MCH nutrition for nutrition professionals and other health professionals who work with women, infants, children, and adolescents. Includes a continuing-education program that focuses on improving the health outcomes of preconceptional, pregnant, postpartum, and breastfeeding women and their infants. LET is part of the School of Public Health at the University of Minnesota.
  
  
• MyPyramid for Pregnancy and Breastfeeding. Provides individualized guidance to meet the unique nutritional needs of women who are pregnant or breastfeeding. A user can input basic data to receive an individualized MyPyramid Plan that provides recommended amounts to eat from each food group, by trimester of pregnancy or stage of breastfeeding. Also includes information on nutritional needs during pregnancy and breastfeeding, weight gain during pregnancy, weight loss during breastfeeding, dietary supplements, food safety, and special health care needs. This section of MyPyramid.gov was developed by the Department of Agriculture's Center for Nutrition Policy and Promotion in conjunction with the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to include specific advice for pregnant and breastfeeding women consistent with the 2005 Dietary Guidelines for Americans. An example of MyPyramid's nutrition guidance includes

  Food safety: Eating fish while you are pregnant or breastfeeding. (2007).

• National Research Council. 2007. Influence of pregnancy weight on maternal and child health: Workshop report. Washington, DC: National Academies Press. This report summarizes a workshop convened to examine the current state of knowledge and highlight key observations that could form the basis for future study and deliberations regarding maternal weight gain during pregnancy.
  
  
• Pregnancy Surveillance System (PNSS). Offers a program-based surveillance system that monitors the nutritional status of approximately 750,000 pregnant and postpartum women with low incomes who are enrolled in federally funded MCH programs. PNSS is a project of CDC's Division of Nutrition and Physical Activity.
  
  
• Supplemental Nutrition Program for Women, Infants, and Children (WIC). Contains program information and data, eligibility criteria, publications, and state agency contact information for this program that provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women and for infants and children up to age 5 who are found to be at nutritional risk. Also see the Food and Nutrition Information Center (FNIC) and its collection of resources about WIC.
  
  
• See MedlinePlus: Folic acid.
  
  
• See the AHRQ report, Screening for iron deficiency anemia: Including iron supplementation for children and pregnant women. Recommendation statement (2006).
  
  
• See CDC's Division of Reproductive Health, CDC's National Center on Birth Defects and Developmental Disabilities (NCBDDD), and the CDC reports, Folate status in women of childbearing age, by race/ethnicity -- United States, 1999-2000, 2001-2002, and 2003-2004 (2007) and Trends in folic acid supplement intake among women of reproductive age -- California, 2002-2006 (2007).
  
  
• Also see the Maternal and Child Health Library, the Food and Drug Administration (FDA), and Planned Parenthood Federation of America (PPFA).
  

  
  

Oral Health

• See the Maternal and Child Health Library's knowledge path, Oral health for infants, children, adolescents, and pregnant women.
  

  
  

Tobacco Use

• 1-800-QUIT-NOW: We Can Help You Draw The Line. Presents contact information for a free service to help consumers stop smoking or chewing tobacco. Callers can speak with a trained quit coach in their state who will work to help the caller quit and avoid the things that tempt people back into the habit. Telephone: (800) QUIT-NOW (784-8669). This is a service of the National Cancer Institute.
  
  
• Bonnie RJ, Stratton K, Wallace RB, eds. 2007. Ending the tobacco problem: A blueprint for the nation. Washington, DC: National Academies Press. This report presents a plan to reduce tobacco use in the United States. The report reviews effective prevention and treatment interventions and considers a set of new tobacco-control policies for adoption by federal and state governments. A chapter is devoted to reducing and preventing tobacco use among pregnant women, parents, and families.
  
  
• Office of the Surgeon General. 2004. The health consequences of smoking: A report of the Surgeon General. Rockville, MD: Office of the Surgeon General. This report focuses on the health effects of active smoking and on diseases related to active smoking. Chapter 5 covers the effects of smoking on fertility, pregnancy, and pregnancy outcomes. Accompanying the report are an executive summary, fact sheets, a database of the key articles cited in the report, a booklet for consumers, and videotapes.

  Also see Children and secondhand smoke exposure (2007). This report presents excerpts from the Health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General (2006).

• Robert Wood Johnson Foundation. 2006. Smoke-free families: State of the Science Capstone Meeting. Princeton, NJ: Robert Wood Johnson Foundation. This report details a conference convened for the researchers, practitioners, and advisers involved in the program, Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy. The report describes the program's accomplishments, recent research findings, and directions for future research and policy.
  
  
• See CDC's Division of Reproductive Health and the fact sheet, Preventing smoking and exposure to secondhand smoke before, during, and after pregnancy, rev. ed. (2007).
  
  
• See ACOG's report, Making the smoking cessation guideline a routine part of prenatal care: Grant results (2007).
  
  
• Also see the Association of Maternal and Child Health Programs (AMCHP), the Maternal and Child Health Library, PeriStats, and the Pregnancy Risk Assessment Monitoring System (PRAMS).
  

  
  

Preconception and Pregnancy: Knowledge Path, 2nd ed. (April 2008). (Updated: March 2010).
Author: Susan Brune Lorenzo, M.L.S., Maternal and Child Health Library.
Reviewers: Yvonne Beasley, M.N., R.N., C.N.A.A., Indianapolis Healthy Start and Marion County Health Department; Marie Godfrey, Ph.D., Genetizen; Olivia K. Pickett, M.A., M.L.S., Maternal and Child Health Library.