Blog | Wednesday, July 20, 2011

QD: News Every Day--IOM seeks 8 new preventive measures for women

Eight preventive health services for women should be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010, according to a report by the Institute of Medicine.

The recommendations encompass diseases and conditions that are more common or more serious in women than in men. They are based on existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. They include:

1) screening for gestational diabetes in pregnant women between 24 and 28 weeks and at the first prenatal visit for women at high risk for diabetes,
2) adding high-risk human papillomavirus DNA testing in addition to conventional cytology testing in women with normal cytology results starting at age 30, and no more frequently than every 3 years,
3) offering annual counseling on sexually transmitted infections for all sexually active women,
4) offering annual counseling and screening for HIV for sexually active women
5) reducing unintended pregnancies through the full range of Food and Drug Administration-approved contraceptives and sterilization procedures, and patient education and counseling for all women who could become pregnant,
6) offering comprehensive lactation support and counseling and costs of renting breastfeeding equipment,
7) screening and counseling for interpersonal and domestic violence, and
8) offering at least one well-woman preventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care.

"This report provides a road map for improving the health and well-being of women," said committee chair Linda Rosenstock, FACP, dean of the School of Public Health at the University of California, Los Angeles. "The eight services we identified are necessary to support women's optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness."

Examples for the recommendations include:
Cervical cancer. Deaths from cervical cancer could be reduced by adding DNA testing for HPV, the virus that can cause this form of cancer, to the Pap smears that are part of the current guidelines for women's preventive services, the report concludes. Cervical cancer can be prevented through vaccination, screening, and treatment of precancerous lesions, and HPV testing increases the chances of identifying women at risk.

Breast feeding. Although lactation counseling is already part of the HHS guidelines, the report recommends comprehensive support. Evidence links breast-feeding to lower risk for breast and ovarian cancers; it also reduces children's risk for sudden infant death syndrome, asthma, gastrointestinal infections, respiratory diseases, leukemia, ear infections, obesity, and type 2 diabetes.

Diabetes. The United States has the highest rates of gestational diabetes in the world. It complicates as many as 10% of U.S. pregnancies each year. Women with gestational diabetes face 7.5 times the risk for Type 2 diabetes after delivery and are more likely to have infants by cesarean section and that have health problems after birth.

Family planning. Unintended pregnancies accounted for almost half of pregnancies in the U.S. in 2001. Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.