A healthy pregnancy outcome depends not only on a woman’s health during pregnancy, but also on her health during the entire life course, including periods before and between pregnancies (1). Therefore, it is crucial for women to lead healthy and active life-styles, get regular health screening, and seek treatment for chronic medical conditions during preconception. The term “preconception health” refers to the health of a woman during her reproductive years (2).

Los Angeles County (LAC) is the most populous county in the US and has a larger population than 42 individual US states. Furthermore, more than 2,180,000 women of reproductive age (15-44 years old) live in LAC and more than 133,000 babies were born in the county in 2010 (3, 4). LAC is also unique with its racial/ethnic diversity, since more than 69% of population is comprised of minorities (5). Thus, the monitoring and planning of preconception health in LAC is especially important and challenging given the unique cultural picture of the county population and the number of women of reproductive age.

To make preconception and interconception health related data accessible to the public, nonprofit organizations, government agencies, and health specialists, MCAH Programs adopted the CDC Core Preconception Health and Health Care Indicators as a frame work and guide for the development of the LAC indicators (6). It is the goal of the project to create uniformity in defining, collecting, and reporting on data relevant to the health status of reproductive-aged women from a variety of data sources available in Los Angeles County. The data sources for the indicators were from several population-based surveys: The Los Angeles Mommy and Baby (LAMB) Survey, for mothers who recently had a live birth; the Los Angeles Health Overview of a Pregnancy Event (LAHOPE), for women who recently had an infant/fetal loss; the Los Angeles County Health Survey (LACHS); and the California Health Interview Survey (CHIS), for all LAC women of reproductive age.

Reproductive age for women is usually defined as 15-44 years old. However, since adolescents have a risk profile different from that of women aged 18 and older, reproductive age is defined as 18-44 (6). No age distinctions are applied to LAMB and LAHOPE indicators as these surveys target women who were able to get pregnant.

The indicators are grouped in the following domains where the detailed description of each indicator and related data are provided:

DOMAINS:

1. General Health Status & Life Satisfaction
2. Social Determinants of Health
3. Health Care
4. Reproductive Health & Family Planning
5. Tobacco, Alcohol & Substance Use
6. Nutrition & Physical Activity
7. Mental Health
8. Emotional & Social Support
9. Chronic Conditions
10. Infections

Please, note that Indicators A1 through J3 are the Core State Preconception Indicators specified by CDC, but in this document MCAH has added additional indicators with lower case suffixes, B1a, B1b, etc., to represent sub-populations and health disparities in LAC. The language defining the indicators may be modified from that of CDC to match available data.

For additional information and project related suggestions, please, contact Margaret Shin Chao at (213)-639-6470 or email schao@ph.lacounty.gov.

References

1. CityMach MCH Life Course Toolbox
2. CDC Preconception Health and Health Care - Women
3. California Department of Finance, Table DP-1. Profile of General Demographic Characteristics: 2010 retrieved from  http://dof.ca.gov/Reports/Demographic_Reports/Census_2010/documents/DP2010-Los_Angeles_County.pdf
4. California Department of Public Health, Vital Statistics Data, TABLE 2-18. LIVE BIRTHS, CALIFORNIA COUNTIES, 2000-2010 (By Place of Residence) retrieved from  https://archive.cdph.ca.gov/data/statistics/Documents/VSC-2010-0218.pdf
5. Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Key Indicator of Health by Service Planning Area, June 2009 retrieved from  http://publichealth.lacounty.gov/docs/keyindicators.pdf
6. Recommendations to Improve Preconception Health and Health Care --- United States A Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm

Acknowledgement

The Project would like to acknowledge the pioneer work of the Public Health WORK Group of the CDC Preconception Health and Health Care Initiative Steering Committee that served as the framework for the  development of the LAC Project.

The Project would also want to thank members of the Preconception Health Collaborative for their invaluable feedback, and all the dedicated MCAH Research, Evaluation & Planning (REP) Unit staff and interns who have contributed their time and effort to the LAMB and HOPE Project.

LAMB project is made possible by the generous support from the Health Resources and Services Administration (HRSA) #R40MC06635, the MCAH General grants, the Productivity Investment Fund (PIF) of the County of Los Angeles Quality and Productivity Commission, and First 5 LA.