The Beginnings Pregnancy Guide was first published in 1989. I’m working on the 8th edition.
The evidence base for the Guide starts with US Public Health Service Guidelines for the Content of Prenatal Care, published in 1989 in the landmark document Caring for our Future, the Content of Prenatal Care.
The Guidelines are still in force. They describe the prenatal care period as pre-conception to the child’s first birthday, a unique opportunity to promote the health of mother, child and family.
The guidelines address three elements of prenatal care: health promotion, screening and intervention. They outline in detail the health promotion content of a minimal quality prenatal care service, emphasizing seven health behavior messages that research links directly to birth outcomes.
I translated these into Key Messages for a Healthy Baby: Eat well. Gain weight. Take vitamins. Don’t drink alcohol. Don’t smoke. Don’t do drugs. Breastfeed your baby.
The evidence base for focusing on these messages grew with a series of studies – the first on the quality of prenatal care – by researchers at the Centers for Disease Control and Prevention published 1993-95. These studies showed 1) few women were getting any information on the key messages (other than “take vitamins”) from prenatal care providers; 2) the information received varied by site of care, provider and factors unrelated to mothers’ interest or need to know, such as race and insurance status; and 3) women of all ages, races, income and education levels who recalled they learned something during prenatal care about the recommended topics had improved outcomes, including a significantly reduced chance of birthing a low-birth-weight baby.
This evidence led to our mantra: It matters what a mother knows.
Since then, it has become clear that it matters more what a mother does. That led to the current focus on enhancing the Beginnings Guides content and teaching strategies to promote parental health literacy – a parent’s ability to use information and services to manage personal and child health and healthcare.
Also since then, I’ve added three key messages based on further evidence, including testing with parents using the guide: 1) Discuss family violence, since pregnancy is a risk factor for initiation or escalation of domestic violence and since violence increases the risk of negative birth outcomes. The American College of Obstetricians and Gynecologists recommends giving information on domestic violence to every pregnant woman and encouraging each to report violence to her prenatal care providers.
Pregnancy Guide readers were 2.3 times more likely to recall this advice than others in the same health plans and same provider panel (p.03).
I’ll be reviewing the literature on each of these key messages and others that may warrant a place on the top 10 list. What messages would you add? Please click on the add comment below to let me know. ss