Dear Colleague Letter from the Commissioner - Preconception Health - September 9, 2016

September 9, 2016

Dear Colleague:

I am writing to provide important information about prevention of maternal mortality and morbidity and to ask you to initiate conversations with women in your care about preconception health, to improve women's health in New York State (NYS).

In November 2015, the New York State Department of Health (Department) joined with the American Congress of Obstetricians and Gynecologists District II, the New York City Department of Health and Mental Hygiene, the Healthcare Association of NYS, the Greater New York Hospital Association, and the New York Academy of Medicine, to form the New York State Partnership for Maternal Health (NYSPMH).The goal of the NYSPMH is to reduce disparities in preventable maternal mortality and morbidity in NYS by focusing on those factors that impact the health of women most at risk of poor pregnancy outcomes.

Maternal mortality and morbidity are key indicators of the health of a society. NYS ranks 46^th among 50 states in maternal mortality rates, and NYS rates remain 1.5 times higher than the Healthy People 2020 objective of 11.4 maternal deaths per 100,000 live births. Despite moderate improvement, significant disparities in maternal deaths persist.

Approximately 45% of births in NYS are unintended, meaning the pregnancy was mistimed, unplanned or unwanted at the time of conception. Therefore, the chance to prepare for a healthy pregnancy and have a proactive conversation with a health care provider has been lost, especially for women with chronic conditions, where preconception health management is critical. In order to address this, the NYSPMH has chosen to focus on preconception careas a starting point to reduce maternal mortality and morbidity. Preconception care is important for all women but especially for those with chronic conditions. As a provider in NYS, you play an important role in assuring the health care women receive supports their pregnancy intentions.

I am asking that you join us by initiating conversations with all female patients of reproductive age, including those being seen for well visits, and ask this one essential question: "Would you like to become pregnant within the next year?". Asking this one essential questionis the responsibility of all health care providers, which include primary care and specialist providers, not just reproductive health providers. A woman's response will guide her primary and specialty care and improve her health outcomes.

Preconception care is key to improving maternal health, and is a goal of the NYS Prevention Agenda. The Prevention Agenda recognizes that women of reproductive age have an increased burden of chronic disease. This means, when they do become pregnant, they may be at a higher risk of pregnancy complications and poor health outcomes. It is imperative for providers to work with their patients and understand patients' pregnancy goals as a step toward improving maternal health. Primary care providers are well positioned to ask women whether they intend to get pregnant, assure they have the right resources to achieve their goal, and assure that other specialists can also support their choice. Additionally, specialists who care for high-risk women should integrate questions on reproductive planning into their visits to adequately address any issues.

Together we need to ensure that all providers of health services talk to women about the importance of preconception care and pregnancy planning.

The NYSPMH has identified the following resources to support you and your practice in improving maternal health. The "Before and Beyond" CME-accredited educational modules focus on various aspects of preconception health including integrating it into primary care and targeting those with high-risk conditions. The programs can be taken online at any time and were developed by the National Preconception Health and Health Care Initiative.

Please contact Doris Maduka of the Department's Division of Family Health at (518) 474-6968, with any questions.

Thank you in advance for your attention to this important issue. Together we can improve maternal health in NYS.

Sincerely,

Howard A. Zucker, M.D., J.D.

Commissioner of Health