The Effect of Preconception Counseling on Health Behaviors in the Preconception and Pregnancy Period Open Access

Abstract

BACKGROUND: The mechanisms for how preconception care can be influence the risk of preterm births is relatively poorly understood. One of the potential pathways for preconception counseling to affect preterm births is through the modifying of health behaviors before and during pregnancy. This study investigates the relationship between preconception counseling health behaviors in the preconception and pregnancy period.

METHODS: Using PRAMS data from 2012 and 2013, women from 31 states and NYC were included in the study. To account for selection bias between women who did and did not receive preconception counseling, propensity score matching using 1:1 matching was used. Preconception behaviors analyzed were diabetes screening, high blood pressure screening, and depression screening, having a healthy BMI, and multivitamin/folic acid intake. Pregnancy behaviors investigated were starting prenatal care in the first trimester, experiencing appropriate gestational weight gain, and smoking cessation.

RESULTS: Reception of preconception counseling was positively associated with screening for diabetes, high blood pressure, and depression, as well as taking multi-vitamin/folic acid supplements every day compared to none. Reception was negatively associated with having a healthy BMI before pregnancy. The only pregnancy period behavior that had a statistically significant result was starting prenatal care in the first trimester.

CONCLUSIONS: Preconception counseling potentially has a large influence on the health behaviors of women before and during pregnancy. To maximize the reach and impact of preconception counseling, more health care workers should be trained to give preconception counseling at all levels of the health care system to increase the likelihood of reception. Medicaid insurance should be expanded to include women who would be eligible for coverage if they were pregnant to improve access and affordability of preconception counseling. Ultimately, this study shows the potential of preconception counseling's influence on health behaviors and provides a foundation for future research.

Table of Contents

Contents

Introduction. 1

Literature Review.. 3

PRETERM BIRTHS. 3

PRECONCEPTION CARE.. 3

Methods. 5

Sample. 5

Andersen Behavioral Model of Health Services Use Framework. 7

Predisposing Measurements. 11

Enabling Measurements. 11

Need Measurements. 12

Hypothesis. 12

Data Analysis. 13

Summary Statistics. 14

Predisposing: AGE, RACE, BMI. 17

Predisposing: General Population. 17

Predisposing: Smoking Population. 17

ENABLING: EDUCATION, INTENTION, INSURNCE BEFORE PREGNANCY, INSURANCE DURING PREGNANCY, KOTELCHUCK, VITAMIN, INCOME.. 17

Enabling: General Population. 17

Enabling: Smoking Population. 17

NEED: PREVIOUS LIVE BIRTH, STRESSORS, SMOKING, ALCOHOL, ABUSE, DIABETES, HBP, DEPRESSION.. 18

Need: General Population. 18

Need: Smoking Population. 18

Regressions. 19

Preconception Period. 19

Diabetes. 19

High Blood Pressure. 20

Depression/Anxiety. 21

Healthy BMI before Pregnancy. 22

Multivitamin/Folic Acid Intake Everyday. 23

Pregnancy Period. 24

Prenatal Care in the 1^st Trimester. 24

Non-Statistically Significant Regressions. 25

Discussion. 25

Strengths. 26

Limitations. 27

Conclusion. 27

Bibliography. 29

Appendix. 33

Table of Figures

Figure 1. Hypothesized Focal Relationship. 13

Tables

Table 1. PRAMS Sequence of Contacts. 5

Table 2. Constructs and Measures. 8

Table 3. Before and After Propensity Scoring Preconception Period.. 14

Table 4. Preconception Behaviors - Propensity Score Matched.. 19

Table 5. Preconception Behaviors -Propensity Score Matched.. 23

Table 6. Pregnancy Behaviors - Propensity Score Matched.. 24

Table 7. Questions and Sources for Variables. 33

Table 8. Preconception Period Non-Propensity and Propensity Scored Proportions. 36

Table 9. Pregnancy Period Non-Propensity and Propensity Scored Proportions. 41

Table 10. Pregnancy Period Non-Propensity and Propensity Scored Proportions. 45

Table 11. Preconception Behaviors -Propensity Score Matched.. 48

Table 12. Preconception Behaviors -Propensity Score Matched.. 52

Table 13. Pregnancy Behaviors -Propensity Score Matched.. 56

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	policy preterm birth health behaviors preconception PRAMS preconception counseling
Committee Chair / Thesis Advisor	Adams, Kat, Emory University
Committee Members	D'Angelo, Denise, CDC Von Esenwein, Silke, Emory University Joski, Peter J, Emory University
Partnering Agencies	CDC

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