Pre-pregnancy alcohol use and timing of prenatal care entry among American Indians and Alaska Natives Open Access

Abstract

American Indians and Alaska Natives (AI/AN) experience among the highest rates of alcohol use and lowest rates of prenatal care use. We examined the association between pre-pregnancy alcohol consumption and timing of prenatal care entry among AI/AN in eight states using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2004-2011. We examined questions about pre-conception alcohol use (and binge drinking) and prenatal care initiation during the first trimester (at or before 12 weeks gestation) among AI/AN respondents in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, and Washington. Pre-pregnancy alcohol users were grouped into non-drinkers, non-binge drinkers, light binge drinkers (1-3 times), and heavy binge drinkers (4+ times during the three months before pregnancy). Data were analyzed using logistic regression in SUDAAN to estimate odds ratios (OR) and 95% confidence intervals (CI) above and below 138% of the federal poverty line (FPL), adjusted for maternal age, education, marital status, pre-pregnancy abuse, pre-pregnancy smoking, pre-pregnancy insurance, and whether trying to get pregnant at the time of conception. At or below 138% FPL, there were no significant associations between quantity of alcohol consumed and timing of prenatal care entry. Above 138% FPL and among 25-34 year olds, heavy binge drinkers were 3.20 times as likely to enter prenatal care early (p=0.007), light binge drinkers were 3.94 times as likely (p<0.0001), and non-binge drinkers were 3.55 times as likely (p=0.001), compared to non-drinkers. Among 25-34-year olds above 138% FPL, AI/AN women who drank pre-pregnancy were more likely to initiate early prenatal care compared to non-drinkers. Further research is required to elucidate these findings.

Table of Contents

Table of Contents I. Background…………………………………………………………………………...1 II. Manuscript…………………………………………………………………………...24 III. Methods……………………………………………………………………………....48 IV. Results………………………………………………………………………………...60 V. Discussion…………………………………………………………………………...63 VI. Appendices…………………………………………………………………………..71 VII. References................................................................83

List of Figures

PRAMS Data Analysis Sample Size Flow Chart (Appendix A)..............................71

Thesis DAG (Appendix B)………….....................................…………………….............72

List of Tables

Table 1. Descriptive statistics of AI/AN women in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, and Washington by pre-pregnancy alcohol use, PRAMS 2004-2011..................................................................................73

Table 2. Crude covariate associations with pre-pregnancy drinking status among AI/AN women in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, and Washington, PRAMS 2004-2011………………..…......................................75

Table 3. Descriptive statistics of AI/AN women in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, and Washington by timing of entry into prenatal care, PRAMS 2004-2011………………………………..…………...........................................77

Table 4. Crude covariate associations with early entry into prenatal care among AI/AN women in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, and Washington, PRAMS 2004-2011........................................................79

Table 5. Adjusted odds ratios for association of pre-pregnancy alcohol consumption and early entry into prenatal care among AI/AN women stratified by federal poverty level (all states)…………………………….....……………………………......................................81

Table 6. Adjusted odds ratios by state for association of pre-pregnancy alcohol consumption with early entry into prenatal care among AI/AN women at or below 138% federal poverty level …………………......................…………........................................82

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Native American Studies Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	prenatal care American Indians pre-pregnancy alcohol Alaska Natives
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Partnering Agencies	State or local health department (not in Georgia) Emory University schools, faculty or affiliated programs CDC

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Pre-pregnancy alcohol use and timing of prenatal care entry among American Indians and Alaska Natives ()	2018-08-28 10:16:33 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions