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

Srinath, Meghna (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/08612n57q?locale=zh
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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

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