Vital health topics overlooked during pregnancy counseling, researchers find

CHAPEL HILL -- Most women receive counseling on various health topics while they're pregnant, but many facing special risks aren't receiving the advice they need, according to a new University of North Carolina at Chapel Hill study.

"Our work suggests that health-care providers should individualize counseling for each patient according to her personal situation, behaviors and experiences much more than they do now," said Dr. Ruth Petersen, research fellow at UNC's Cecil G. Sheps Center for Health Services Research.

Petersen and colleagues conducted their study since little research exists on how often pregnant women are asked about preventive health topics, she said. Prenatal care is a perfect time to provide preventive health counseling since most women receive medical care during their pregnancies.

"Poor pregnancy outcomes can often be linked to a limited number of high-risk behaviors such as substance use and poor diet, which can be modified by behavioral changes," the physician said. To learn how often women were counseled on health issues during pregnancy, her group analyzed data from the Pregnancy Risk Assessment Monitoring System, a survey of nearly 25,000 postpartum women. They based their list of relevant topics on recommendations from the U.S. Preventive Services Task Force.

Most topics were well-covered by health-care providers, researchers found. More than 80 percent of surveyed women reported discussions about cigarette and alcohol use, nutrition, breast-feeding, pre-term labor, family planning after pregnancy, medication use during pregnancy, fetal growth and development and HIV testing.

Other subjects were less likely to be covered, however, including domestic violence, seat belt use, illegal drugs and the risk of contracting HIV, the virus that causes AIDS. Only 31 percent of women surveyed received counseling on violence, and only 51 percent were advised how to avoid HIV. Forty-seven percent got no information about seat belt use, and 27 percent weren't counseled about drug use hazards.

A report on the findings appears in the May issue of the American Journal of Preventive Medicine. Besides Petersen, authors are Alexandra Connelly, a doctoral student in epidemiology; Dr. Sandra Martin, associate professor of maternal and child health; and Dr. Lawrence Kupper, professor of biostatistics, all at the UNC School of Public Health.

Counseling about some issues was not targeted to the needs of individual women, researchers also found. Those in greater need of advice about breast- feeding, violence and pre-term labor, for example, received no more counseling on those topics than did other women.

In contrast, pregnant women who smoked and drank alcohol were more likely to receive advice on those subjects than women who didn't smoke or drink.

"Preventive health practice guidelines may need to include efficient, effective and reliable ways to assess patients' risks and to provide focused counseling according to those risks," Petersen said.

One limitation of the study was that it relied on patients' memories rather than on written health records of what counseling was offered, she said. "More research on how effective counseling is in improving women's health during pregnancy is needed, as well as further studies of what counseling methods work best," Petersen said.

The study was supported in part by a National Research Service Award Postdoctoral Traineeship from the Agency for Healthcare Research and Quality.

Note: Petersen can be reached at (919) 966-7924.

UNC News Services