Data and Trends

Creating Indicators for Preconception Health

Preconception health encompasses a wide range of health issues that includes managing or preventing chronic diseases, maintaining a healthy body weight, testing and treatment for sexually transmitted diseases and folic acid intake. Proper preconception care is essential to improving birth outcomes as well as overall health. Many states are in the early stages of implementing preconception health programs in their state and are facing the challenges of determining how to measure programs. The ability to assess preconception health efforts is a crucial component of this work, but how does one know whether a particular program or intervention is working? What are the measurements for effectiveness?

In December 2007, seven states (California, Delaware, Florida, Michigan, North Carolina, Texas and Utah) came together to create the Core State Preconception Health Indicators Working Group. The purpose of this group was to develop a set of indicators for preconception health efforts targeting women 18 to 44 years of age. Using existing state level, population based databases, the group created a set of proposed indicators that could be used by states to evaluate preconception health efforts. The group used a structured process to identify 11 domains of health (e.g., general health status, social determinants of health, reproductive health and family planning, etc) and five population based data systems (e.g., BRFSS, PRAMS, etc.). After evaluating and prioritizing the list of potential indicators, the group created a final set of 45 core preconception indicators. Presented below is a table including some of the resulting indicators, domains and data sources from which information could be collected.

This table is an excerpt from a larger table presented in an article published in the Maternal and Child Health Journal: Broussard DL, Sappenfield WB, Fussman C, Kroelinger CD, Grigorescu, V. Core State Preconception Health Indicators: A Voluntary, Multi-state Selection Process. Maternal Child Health Journal. 2010 Mar 12.


Preconception health indicators, domains and sub domains for women 18 to 44 years old


Sub Domain


Data Source

Health care

(Seven indicators related to this domain)

Access to and utilization of health care








Access to dental care


Reproductive health care


Content and quality of care

·         Percentage of women who currently have some type of health care coverage

·         Percentage of women having a live birth who had health care coverage during the month prior to pregnancy

·         Percentage of women who had a routine checkup in the past year

·         Percentage of women having a live birth who had a postpartum checkup

·         Percentage of women having a live birth who had their teeth cleaned 12 months prior to pregnancy

·         Percentage of women who had a pap test within the past 3 years

·         Percentage of women having a live birth who received preconception counseling about healthy lifestyle behaviors and prevention strategies from a health care provider prior to pregnancy









BRFSS b, c




Mental Health

(Three indicators related to this domain)

General mental distress

Anxiety and depression 


Postpartum depression

·         Percentage of women who report that their mental health was not good for at least 14 out of the past 30 days

·         Percentage of women having a live birth who visited a health care provider to be checked or treated for anxiety or depression during the 12 months prior to pregnancy

·         Percentage of women having a live birth who experienced depressive symptoms after pregnancy








PRAMS=Pregnancy Risk Assessment Monitoring System
BRFSS=Behavioral Risk Factor Surveillance System

NVSS=National Vital Statistics System
ASEC=Annual Social and Economic Survey


a Indicator measure is a PRAMS standard item, which is not available in all PRAMS states

b Indicator measure is a BRFSS rotating core item, which is available in all states only in even years

c Indicator measure is also available as a BRFSS optional module, which can be added in odd years