WOMEN'S HEALTH ISSUES
Care before conception
Insurance coverage of pre-pregnancy care is urged
Thirty-five national organizations want care for women before they become pregnant to be incorporated in the health care system, says a national official.
There is "huge interest" in the idea of pre-conception care in the United States and internationally, said Dr. Hani Atrash, associate director for program development, National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention.
Atrash was a key speaker this week at a conference on "New Frontiers in Maternal and Infant Health Care: Ethics, Outcomes and Practices in the 21st Century" at the Hale Koa Hotel.
More than 175 health professionals, students and health policy leaders attended the meetings, sponsored by the Healthy Mothers Healthy Babies Coalition of Hawaii and the Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine.
Nancy Partika, coalition executive director, said, "Society pays a lot of attention to women who are pregnant, but not necessarily at other times." Providing pre-conception care would improve the health of all women, she said.
In his talk and later in an interview, Atrash said that although most pregnant women in the United States get prenatal care, adverse pregnancy outcomes remain a major health problem.
According to the CDC, 12 percent of babies are born premature, 8 percent are born with low birth weight, 3 percent have serious birth defects and 31 percent of women giving birth have complications.
The CDC also says that 11 percent of women smoke during pregnancy, and 10 percent drink alcohol. Of those who could get pregnant, 69 percent do not take folic acid, 31 percent are obese and about 3 percent take prescription or over-the-counter drugs known as teratogens, which damage the fetus.
About 4 percent of women have medical conditions, such as diabetes, hypertension or hypothyroidism, that can harm a pregnancy if they are unmanaged, the CDC reported.
Pre-conception care could prevent and reduce risks to a pregnancy or birth, Atrash said. "Unfortunately, most providers don't provide it. Most insurers don't pay for it. Most consumers don't ask for it."
Age-appropriate pre-conception care and counseling was one of the national health objectives in 2000, but it is not listed in the 2010 goals, he noted.
He said the CDC recognized the need for a national approach to improve birth outcomes and formed a working group, which held a summit for concerned U.S. organizations and countries.
Recommendations and action steps were proposed for pre-conception health care aimed at promoting a woman's health throughout her life, Atrash said.
The organizations working on pre-conception care hope to prove it makes scientific and business sense so insurers will pay for it, he said.
CDC says each child born with a disability leads to direct and indirect costs of more than $1 million over his or her lifetime. If pre-conception care can prevent that, Atrash said, "if you're Kaiser or Blue Cross, how can you argue with it?
"What's missing is how do we integrate the concept into the public health system and make it a standard of care," he added, pointing out "one size doesn't fit all" because of individual health issues.
"The challenge is social marketing, not only to the consumers, but to providers, hospitals, public health departments, insurers and others," he said.
Women at high risk of mood problems after birth
The period after giving birth is a "very high-risk time" for women, with up to 80 percent having what are called "blues" and some experiencing serious depression, says a leader in the neuropsychiatric field.
Prior postpartum difficulties, history of depression or a bipolar condition are risk factors, said Dr. Vivien Burt, psychiatry professor at the David Geffen School of Medicine, University of California-Los Angeles.
The blues involve moodiness that comes and goes, said Burt, also director of the Women's Life Center of the Resnick Neuropsychiatric Hospital.
If symptoms become so severe that they are disabling or they last more than 12 days, "we're not talking about blues anymore," she said. "It's depression."
Burt discussed "Treatment Options for Mood Disorders in Pregnancy and Postpartum" at a conference here this week sponsored by the Healthy Mothers Healthy Babies Coalition of Hawaii and John A. Burns School of Medicine's Department of Obstetrics, Gynecology and Women's Health.
Elaborating in an interview, Burt said it is important for doctors in a six-week checkup after delivery to assess a mother for postpartum depression, especially if it occurred after a previous pregnancy.
Risk factors often include a poor marriage, no spouse, lots of kids and no one to help, economic or other burdens, and "having never planned for pregnancy and not adapting to it," she said.
About 13 percent to 14 percent of women giving birth suffer from postpartum depression, she said, adding that a woman who is depressed during pregnancy has the highest risk of suffering the illness.
Symptoms include someone in a persistently sad mood, who cannot sleep, is agitated, often obsessing about the baby's health and cannot look after the baby, she said. "Depressed mothers are absent mothers. They can't take care of their children."
A mother paralyzed with depression also might consider suicide, thinking life is not worth living and that her family would be better off without her, Burt said.
But postpartum depression is treatable with medicine and support for the mother through group therapy or individual psychotherapy, she said.
Burt said actor Tom Cruise "did us a favor" recently in focusing attention on postpartum depression during a media feud with actress Brooke Shields.
Cruise criticized Shields for using antidepressants for postpartum depression, described in her book, "Down Came the Rain: My Journey Through Postpartum Depression."
A Scientologist, Cruise said women with postpartum depression do not need medication and can be cured with vitamins or exercise. That triggered an outcry from Shields, other women and advocacy organizations for the mentally ill.
"Postpartum is a tough time in a woman's life," Burt said, stressing that postpartum depression is "an illness as real as diabetes" or any other medical condition.
Cruise's remarks were "uninformed" and "laughable," Burt said. "Brooke Shields came out looking good. He reinvigorated her career."