Research Articles
Preventive Counseling During Prenatal Care
Pregnancy Risk Assessment Monitoring System (PRAMS)
Ruth Petersen, MD, MPH, Alexandra Connelly, MSPH, Sandra L. Martin, PhD, Lawrence L. Kupper, PhD
Background: Prenatal care provides an opportunity for counseling about behaviors and experiences that
increase the likelihood of adverse maternal and fetal outcomes.
Objectives: To document (1) prevalence of preventive health counseling during prenatal care,
(2) prevalence of women in higher need of counseling about specific health concerns, and
(3) whether women in higher need for counseling were more likely than women in lower
need to have received counseling.
Methods: Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS), a state-specific,
population-based, random sample of postpartum women, was performed by using data
from 14 states for births during 1997 or 1998, for a total of 24,620 participants. Outcome
measures included report of preventive health counseling during prenatal visits by specific
topic as well as behaviors and experiences about cigarette use, alcohol use, breast-feeding,
partner violence, and preterm labor.
Results: The percentage of women that report preventive counseling during prenatal care is
relatively high (75%) for 9 of 13 topics. However, the percentage of women that report
counseling is relatively low (75%) for partner violence, seat belt use, illegal drug use, and
human immunodeficiency virus (HIV) risk. Except for counseling about cigarette and
alcohol use, women in higher need, compared with women in lower need, for three other
health topics were not significantly more likely to receive counseling.
Conclusions: Preventive health counseling for partner violence, seat-belt use, illegal drug use, and risk
of HIV could be increased across prenatal settings. Counseling should involve assessment
of risks, with focused counseling related to those risks.
Medical Subject Headings (MeSH): counseling, domestic violence, HIV, prenatal care,
preventive health services, seat belts, street drugs (Am J Prev Med 2001;20(4):245–250)
© 2001 American Journal of Preventive Medicine
Introduction
O
ne of the main premises behind preventive
health care is to identify behaviors that may
put an individual at risk for a specific morbid-
ity or mortality and to affect change in that individual’s
risk-taking behavior. This is a two-step process that
involves assessing a patient’s risk-taking or health-pro-
moting behaviors and then providing counseling about
risks and benefits in a supportive, clear, and unbiased
manner.
1
In an effort to advance the mission of preventive
health practice, the U.S. Preventive Services Task Force
compiled the landmark Guide to Clinical Preventive Ser-
vices.
1
The collection of expert review and testimony led
to recommendations for the types of preventive inter-
ventions that should be performed during clinical visits.
These interventions are grouped into three categories,
including screening, counseling, and chemoprophy-
laxis. In an effort to promote preventive health practice
in clinical settings, the Task Force recommended that
preventive health practices “must specifically address
patients’ personal health practices” and healthcare
providers “must take every opportunity to deliver pre-
ventive services.”
1
Despite the literature and protocols that support the
practice of preventive health care in medicine, there
are important differences between recommended prac-
tices and actual provider performances in preventive
health counseling.
1–3
The prevalence of preventive
health counseling has been examined from different
perspectives, including that of the provider
2,3
and of
From the Cecil G. Sheps Center for Heath Services Research
(Petersen), Department of Maternal and Child Health (Petersen,
Martin), Department of Epidemiology (Connelly), Department of
Biostatistics, (Kupper), University of North Carolina, Chapel Hill,
North Carolina
Address correspondence and reprint requests to: Ruth Petersen,
MD, MPH, Cecil Sheps Center for Health Services Research, UNC-
CH, CB #7590, Chapel Hill, NC 27599-7590. E-mail:
ruth_petersen@unc.edu.
245 Am J Prev Med 2001;20(4) 0749-3797/01/$–see front matter
© 2001 American Journal of Preventive Medicine • Published by Elsevier Science Inc. PII S0749-3797(01)00302-6