The Effect of Socioeconomic Status and Maternal Race-Ethnicity on Prenatal Diagnosis and Birth Outcomes among Pregnancies with Birth Defects in Metropolitan Atlanta from 1995 to 2008 Público

Abstract

Objectives: The purpose of this study was to assess the effect of socioeconomic status and maternal race-ethnicity on elective termination after prenatal diagnosis of a congenital anomaly. This study aims to describe the current state of elective termination after prenatal diagnosis and to highlight this relationship with regards to current prevalence estimates of congenital anomalies.

Methods: Using population-based surveillance data from the Metropolitan Atlanta Congenital Defects Program (MACDP) from 1995 to 2008, we calculated prevalence estimates of the selected congenital anomalies. Logistic regression was used to assess the maternal age adjusted effects of socioeconomic status and maternal race-ethnicity on the odds of elective termination after prenatal diagnosis of a congenital anomaly. A standardized neighborhood deprivation index was used as a socioeconomic status measure and was measured at the census tract level.

Results: The prevalence of the selected defects varied by maternal race-ethnicity and maternal age. Maternal race-ethnicity was associated with elective termination after prenatal diagnosis of a birth defect. Hispanic mothers are the least likely to terminate after prenatal diagnosis of a congenital anomaly (aOR = 0.46 95% CI: [0.36-0.60]) followed by non-Hispanic black mothers (aOR = 0.68 95% CI: [0.57-0.81]). Neighborhood deprivation was also associated with elective termination after prenatal diagnosis. Women in high deprivation neighborhoods are less likely than those in low deprivation neighborhoods to have an induced abortion following a prenatal diagnosis of a birth defect (aOR = 0.79 95% CI: [0.65-0.96]). There was evidence of interaction between neighborhood deprivation and maternal age.

Conclusion: While the congenital anomaly prevalence is higher among non-Hispanic whites, non-Hispanic blacks and Hispanics are less likely to terminate a pregnancy that is known to be affected by a congenital anomaly. Women in more deprived neighborhoods are also less likely to terminate such a pregnancy. More research needs to be done to determine the etiology of racially varying congenital anomaly prevalence.

Table of Contents

Chapter 1. Background. 1

Chapter 2. Manuscript. 13

Abstract. 13

Introduction. 14

Methods. 15

Results. 19

Discussion. 23

Chapter 3. Discussion. 27

References. 32

Tables. 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	Birth Outcomes Disparities Birth Defects Abortion Elective Termination Social Ethnicity Epidemiology Congenital Anomalies Race Socioeconomic Status
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Committee Members	Cragan, Janet, Centers for Disease Control and Prevention
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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