What’s the most important thing we can do to ensure a good birth outcome?  During the 1980s and 1990s, public health focused on the importance of prenatal care and ensuring that every woman got into prenatal care early in the pregnancy and continued with consistent care throughout the pregnancy.  Programs like Health Start enlisted lay health workers in communities to identify women early in their pregnancy and link them with prenatal care were successful in improving our prenatal care rates.   In 1999, Arizona was one of the first states to employ a new analytic method called the Perinatal Periods of Risk Model to examine birth and death records to pinpoint the greatest risk for poor birth outcomes.

To our surprise, we found that the greatest contributing factor to poor birth outcomes were conditions that existed prior to pregnancy.  Things like the general state of the mother’s health including nutrition, tobacco and alcohol use, and chronic conditions such as obesity, diabetes and high blood pressure.  A major shift began at that point to focus more resources on women’s health including family planning, nutrition and physical activity and early screening, diagnosis and control of chronic conditions prior to pregnancy.  It turns out that obesity has become the most common risk factor for a poor birth outcome because of the link to complicating conditions that increase risk in pregnancy.  For more information on the department’s efforts around preconception care, check out the website for Perinatal Periods of Risk analysis and Every Woman Arizona materials.