Maternal Socioeconomic Status and the Odds of Failing to Receive Preconception Counseling: an Epidemiologic Study Using 2009-2011 PRAMS Data Público

Nystrom, Katherine (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/rn301221q?locale=es
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Abstract

Objectives: To determine the degree to which maternal characteristics, psychosocial factors, and health behaviors explain or mediate the influence of socioeconomic factors on the receipt of preconception counseling.

Methods: Secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 6 states (Hawaii, Maryland, Michigan, Minnesota, Utah, and West Virginia) that included the following question in their PRAMS questionnaire: "Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to prepare for a healthy pregnancy and baby?" The sample is a population-based sample of 27,458 women who gave birth to a live infant during the years 2009-2011.

Results: Women of low socioeconomic status disproportionately had poorer health behaviors and access to health care services in regards to preconception health. For example, among women with an income of less than $10,000, 72.5% reported that their recent pregnancy was unintended. Among women with less than 12 years of education, 69.2% reported that their recent pregnancy was unintended. Pre-pregnancy multivitamin use among women earning less than $10,000 annually was 27.1%, and pre-pregnancy multivitamin use among women with less than 12 years of education was 30.8%. Only 32.7% of respondents received preconception counseling. By using multivariable logistic regression, we found modest evidence for income and education variation, although not in a clear dose-response gradient. We observed a protective, albeit non-significant, effect of extreme poverty (annual income

Conclusions for Practice: To prevent adverse pregnancy and infant outcomes, preconception counseling should be incorporated into public health programs and interventions targeted to all women of reproductive age. Currently, the provision of preconception counseling, or women's recognition of the receipt of preconception counseling, remains substandard. While scientific evidence is growing to support the improvement of women's preconception health as an effective way to reduce poor pregnancy and infant outcomes, further research is needed to assess the effectiveness of preconception health programs and policies.

Table of Contents

BACKGROUND ........................................................................................................................... 1

Introduction to Preconception Health ............................................................................................... 1
Preconception Health Indicators ..................................................................................................... 4
Preconception Counseling .............................................................................................................. 6
Barriers and Enablers to Preconception Care ..................................................................................... 9
Barriers ..................................................................................................................................... 9
Enablers .................................................................................................................................... 10
Women of Low Socioeconomic Status ............................................................................................. 11
Impact of Low Socioeconomic Status .............................................................................................. 12
Solutions ................................................................................................................................... 13
Policy Implications and Access to Preconception Counseling ................................................................ 15
Gaps in the Literature................................................................................................................... 16
Research Purpose and Questions .................................................................................................... 18
METHODS ................................................................................................................................. 20
Design and Sample ...................................................................................................................... 20
Measures ................................................................................................................................... 21
Analytic Strategy ......................................................................................................................... 23
RESULTS ................................................................................................................................... 25
DISCUSSION ............................................................................................................................. 30
STRENGTHS AND WEAKNESSES .................................................................................................. 32
FUTURE DIRECTIONS ................................................................................................................ 32
REFERENCES ............................................................................................................................. 34
TABLES ..................................................................................................................................... 37
APPENDIX .................................................................................................................................. 48

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