Pregnancy Nutrition Surveillance System - Maternal Behavioral Indicators

Article Index


Maternal Behavioral Indicators

Medical Care indicates the month in which prenatal care began for the current pregnancy. Medical care data are always collected at the prenatal visit. It must be collected at the postpartum visit if the woman was not enrolled in the program participating in the PNSS while she was pregnant or if she reported at the prenatal visit that she had not begun medical care. The American College of Obstetricians and Gynecologists (ACOG) has established guidelines in Standards for Obstetric-Gynecologic Service to monitor the progress of the mother and developing fetus, which call for early entry into care with at least 13 visits during a full-term pregnancy. (Healthy People 2010) Women who begin prenatal care after the first trimester are at a higher risk for poor pregnancy outcomes with infants being born premature, low birthweight or growth retarded. (Alexander and Korenbrot, 1995; IOM, 1990; USDA, 1991) Although a large proportion of women receive early and adequate prenatal care, there is great variation across racial ethnic groups and among some age groups. (Healthy People 2010) Consequently, DHHS continues its health objective for 2010 to increase to 90 percent the proportion of women who receive early and adequate prenatal care. (Healthy People 2010).


WIC Enrollment is defined as the date the woman enrolled in WIC for the current pregnancy. This indicator is used to determine the length of WIC exposure for this pregnancy, which is related to birth outcome. A number of studies considering WIC participation, low birthweight and prematurity concluded that prenatal WIC participation is associated with improved birthweights and a reduction in pre-term delivery. (Devaney et. al 1992, Abrams, 1993). Additionally, Ahluwalia et. al. concluded that WIC participation resulted in a reduction in small for gestational age deliveries. Furthermore, longer enrollment in WIC program was associated with a reduced risk of small for gestational age delivery. (Ahluwalia,1998) 

Multivitamin Consumption refers to the intake of multivitamin supplements containing the recommended amounts of folic acid prior to pregnancy and iron during pregnancy.

  • In 1992 the U. S. Public Health Service recommended that all women of childbearing age consume at least 400 ug of folic acid daily. (CDC, 1992) Multivitamins contain the recommended 400 ug of folic acid . Consumption of folic acid at this level prior to pregnancy is expected to lead to achievement of the Healthy People 2010 objective to increase the proportion of pregnancies that are begun with an optimal level of folic acid. Adequate folic acid intake before pregnancy reduces the risk of a pregnancy affected by neural tube defects such as spina bifida and anencephaly. It is estimated that the NTD incidence in the U. S. could be reduced by 50 percent with adequate folic acid intake. (CDC, 1992)
  • The 1998 CDC Recommendations to Prevent and Control Iron Deficiency in the United States indicates that primary prevention of iron deficiency during pregnancy includes adequate dietary iron intake and iron supplementation. Pregnant women should start oral, low-dose (30mg/day) supplements of iron at the first prenatal visit and they should be encouraged to eat iron-rich foods and foods that enhance iron absorption. Multivitamins contain the recommended 30 mg of iron. Iron deficiency anemia during pregnancy increases the chance of preterm delivery and delivery of a low birthweight infant. (CDC, 1998)