Extended prenatal care could help to better address chronic illness.(Obstetrics)

WASHINGTON -- The term "prenatal care" should be rethought to include much more of a woman's life cycle, Dawn Misra, Ph.D., said at a meeting sponsored by the Jacobs Institute of Women's Health.

"We have to go beyond the [typical] prenatal period" of a few months before pregnancy, said Dr. Misra of the University of Michigan, Ann Arbor. When it comes to chronic illnesses that may affect pregnancy, for example, "we have to plan strategies to address these matters across the life course; if we want to fix them, we can't wait until pregnancy to [address] them."

Dr. Misra gave hypertension as an example. "There really is no good treatment for hypertension once you're pregnant," she said. "You can do some things to try to moderate its effects and lessen its impact, but you can't fix it. So [instead] we could prevent women from having hypertension and entering pregnancy with hypertension." This involves addressing such chronic health problems in the preconception period as well as between pregnancies.

She gave several reasons why providers haven't taken this approach. "Public health and medical professionals are wedded to the notion that prenatal care is fundamental," she said. "There have been a lot of successes with prenatal care, but I would like to take a step back and think about how prenatal care is not the only answer."

The health care financing system has encouraged this model of prenatal care by the way it reimburses for care, she continued. As a result, "very few women get no prenatal care, yet we haven't achieved much improvement in terms of infant outcomes."

Changing this system of care would also mean increasing involvement by providers outside the specialty of ob.gyn., such as ...