Washington, DC—Among continued efforts to reduce maternal morbidity and mortality, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released new recommendations designed to improve women’s overall life health by focusing on a set of interventions between pregnancies. Published in Obstetrics & Gynecology and the American Journal of Obstetrics & Gynecology, Interpregnancy Care, the latest in the Obstetric Care Consensus series, is endorsed by both the American College of Nurse-Midwives and the National Association of Nurse Practitioners in Women’s Health.
“We are looking at pregnancy as a window to the woman’s future health,” said Judette Louis, MD, MPH, coauthor of the document. “The interpregnancy period is an opportunity for women’s health care providers to address complications and medical issues that develop during pregnancy, assess a woman’s mental and physical well-being, and optimize her health along her life course.”
Complications during pregnancy such as gestational diabetes, gestational hypertension, preeclampsia, and fetal growth restriction are associated with risk of health complications later in life.
All women of reproductive age who have been pregnant, regardless of the outcome of their pregnancies (i.e., miscarriage, abortion, preterm, full-term delivery), should receive interpregnancy care. It should also be acknowledged that not all women will want to or will have subsequent pregnancies or children.
To optimize the health of women and possible future children, ACOG and SMFM recommend that obstetric care providers begin discussing interpregnancy care during pregnancy. A well-developed postpartum care plan can help address the transition to parenthood and interpregnancy or well-woman care.
Interpregnancy care includes breastfeeding support, reproductive life planning, screening for depression, weight loss if needed, vaccination, tobacco cessation, an assessment of social determinants of health (e.g., access to food and housing), screening for intimate partner violence and sexually transmitted infections, and more. In certain high-risk populations, additional counseling and interventions such as genetic counseling should be considered.
“Providers have long understood the role of interpregnancy care as an intervention to improve neonatal outcomes. Recently and importantly, interpregnancy care has been recognized for its role in maternal health,” said Allison Bryant, MD, MPH, coauthor of the document. “Improved maternal health at the start of the next pregnancy leads to improved long-term health for the woman.”
This guidance is being issued simultaneously with ACOG Committee Opinion 762, Prepregnancy Counseling. The document, jointly developed with the American Society for Reproductive Medicine, provides guidance on counseling women about their health before pregnancy and will be released in both Obstetrics & Gynecology and Fertility and Sterility. The guidance aims to help women address health concerns prior to pregnancy to reduce the risk of pregnancy-related harms to the mother and neonate. Much of the guidance included in the new document has long been established, but this is the first time this information has been gathered into one comprehensive document. Together, the ACOG/ASRM Committee Opinion, the joint ACOG and SMFM Obstetric Care Consensus, and existing obstetrical guidance work to provide a complete overview of women’s health before, during, and after pregnancy and across women’s life spans.
The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. www.acog.org
The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership organization representing the interests of obstetricians/gynecologists who have additional formal education in maternal-fetal medicine. The Society is devoted to reducing high-risk pregnancy complications by providing continuing education to its more than 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. SMFM hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed. For more information, visit www.smfm.org.