Background:
Risk factors for poor pregnancy outcomes include maternal age, race, the presence of maternal health problems, smoking and other behavioral risks, short inter-pregnancy interval, and a prior poor pregnancy outcome. Addressing modifiable risk factors during the preconception, prenatal and inter-conception periods may improve rates of prematurity and infant mortality.

Objectives:
To develop and implement a program targeting preconception risk factors for a cohort of women receiving clinical care at a multidisciplinary urban teaching practice.

Methods:
Prospective cohort, baseline characteristics.

Results:
During the first 3 months of program implementation we have enrolled 174 preconception and 220 prenatal patients. The average age is 24 for each group. Overall, 65% are African American, 80% are single, 66% receive Medicaid, 17% are uninsured, 36% are unemployed, 6% are full time students, and 18% report an unstable housing situation. Approximately 90% live in one of the high risk zip codes within our target county. Seventy-five percent are multigravidas; 23% of those report a prior poor pregnancy outcome. Almost 20% of those enrolling during the prenatal period are teens. Medical risks are prevalent with 26% reporting a history of depression, 19% a history of asthma, 7% hypertension, 2% diabetes, 2% thyroid disease, and <1% known HIV at enrollment. Obesity was seen among 34% and 3% were underweight. Within the cohort 29% smoke, 27% report some alcohol use and 7% some illicit drug use. Among the women presenting for prenatal care rates of pregnancy planning activities were low, with 88% of pregnancies unplanned; among those women seen for medical or gynecologic care effective contraception use was reported by approximately 50%. Folic acid containing vitamins were taken by 35% overall.

Conclusion and implications for practice:
Implementation of a preconception care program within an urban teaching practice has allowed us to quickly reach a high risk population. Programs targeting high risk populations can be integrated into existing clinical practices and will need to blend social, nutritional, behavioral, and financial services with interventions to address medical morbidity and improved use of effective contraception.