Background:
In April 2006, the Centers for Disease Control and Prevention (CDC) published 10 recommendations to improve health for women prior to and between pregnancies, one of which was to maximize available public health surveillance systems to monitor the status of preconception health in the US. The Pregnancy Risk Assessment Monitoring System (PRAMS) can provide data to monitor behaviors, conditions and outcomes related to preconception health.

Objectives:
The objective is to assess the pre-pregnancy prevalence of maternal behaviors and health conditions related to birth outcomes among women who recently delivered a live infant.

Methods:
We analyzed 2004 data from PRAMS in 26 states. Up to 3 mailed surveys were sent to women who recently delivered a live infant 2-6 months postpartum; nonrespondents were followed up by phone. Weighted response rates exceeded 70%. We used SUDAAN software for the analysis.

Results:
The prevalence of pre-pregnancy behaviors and experiences was as follows: tobacco use ranged from 12.3% to 39.5%, alcohol use ranged from 25.3% to 66.8%, multivitamin use 4 or more times a week ranged from 26.7% to 43.6%, and physical abuse ranged from 2.2% to 7.3% (26 states). The prevalence of receiving pre-pregnancy health counseling ranged from 24.1% to 34.8% (5 states). For medical conditions, pre-pregnancy overweight ranged from 26.8% to 40.1% and pre-pregnancy diabetes ranged from 0.9% to 5.7% (26 states). The prevalence of pre-pregnancy asthma ranged from 6.1% to 10.8%, and pre-pregnancy anemia ranged from 5.2% to 12.3% (4 states). Among multiparous women, the prevalence of having a previous low birth weight infant ranged from 5.7% to 15.0% and the prevalence of having a previous preterm infant ranged from 7.7% to 16.7% (26 states).

Conclusion and implications for practice:
In some states many women reported desirable behaviors and health status in the preconception period, although overall estimates suggest that improvements are needed for all women to enter pregnancy in optimal health. PRAMS data can be used to monitor the status of preconception health, and can track improvements as the CDC's recommendations are implemented. These findings can be used to develop programs and policies to improve women's health.