Background:
Preconception care (PCC) visits provide opportunities for women to gain awareness and understanding into how their health behaviors and family histories impact their future pregnancies. Behaviors such as tobacco and alcohol use, and the absence of folic acid consumption can adversely impact the health of the fetus. To be the most beneficial, substance use cessation and vitamin consumption should begin before conception. Although the importance of PCC is well documented, less known is who receives preconception care, and more importantly, who does not.

Objectives:
Participants will learn who is in greatest need for preconception care in Oklahoma.

Methods:
Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2004-2005 were used to analyze behaviors in four areas, smoking, alcohol use, folic acid awareness and consumption, for women who did not receive PCC (n=3186). A detailed review of the methodology of PRAMS has been previously published. Prevalence estimates and chi-square tests were used to determine which women were most in need of PCC.

Results:
Approximately 86.5% of OK women did not receive PCC in 2004-2005. Women more likely to report no PCC were aged 20-24 (92.9%), Hispanic women (92.2%), those who did not have insurance prior to conception (91.3%), women with less than a high school education (90.7%), and American Indian mothers (88.0%). Risk behaviors reported among women not receiving PCC were high; 50.1% of women reported drinking in the 3 months prior to pregnancy, 33.7% reported smoking; 34.9% were not aware of the benefits of folic acid and 74.8% were not taking a multivitamin 4 or more times per day. Among women trying to get pregnant, 64.9% were not taking a regular multi-vitamin and 21.4% were smoking prior to pregnancy.

Conclusion and implications for practice:
Most women in Oklahoma do not receive preconception counseling prior to pregnancy. Research shows that efficacious counseling methods for PCC exist and a consistent effort should be made by public health entities in the state to make PCC affordable and available for all women. Awareness campaigns on the importance of PCC visits are needed, as illustrated by the large number of women trying to get pregnant who reported not receiving preconception care.