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Predictors of Preconception Care and Birth Defects Prevention

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Most birth defects arise before woman knows she is pregnant. ... efforts aimed at folic-acid preventable NTDs must be aimed at non-pregnant women. ... – PowerPoint PPT presentation

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Title: Predictors of Preconception Care and Birth Defects Prevention


1
Predictors of Preconception Care and Birth
Defects Prevention
  • Amy Case, MAHS
  • Tunu Ramadhani, Ph.D.
  • Mark Canfield, Ph.D.
  • Texas Department of
  • State Health Services

2
Background
  • Birth defects structural or chromosomal
    abnormalities diagnosed prenatally or within one
    year of delivery.
  • Most birth defects arise before woman knows she
    is pregnant.
  • Example the neural tube must close by about 4
    weeks post-conception. Therefore, efforts aimed
    at folic-acid preventable NTDs must be aimed at
    non-pregnant women.

3
Background
  • Other examples of preventing birth defects though
    preconception care
  • Rubella Immunization
  • Toxoplasmosis Screening
  • Diabetes, Epilepsy Control
  • Medication Management
  • Occupational Risk Assessment
  • Substance Abuse Assessment

4
Texas Womens Health Survey
  • Sample size about 1200 Texas women ages 18-44
  • Oversampling of Hispanics, African-Americans and
    less populated regions
  • Response Rate More than 80 of eligible women
    completed the interview
  • Survey questions in either Spanish or English

5
Texas Womens Health Survey
  • Funded through a CDC Cooperative Agreement
  • Modeled on March of Dimes National Gallup Poll
  • 15-minute Computer-Assisted Telephone Interview
    (CATI) focusing on folic acid knowledge,
    supplement use, and birth defects prevention

6
Methods Survey Questions
  • Respondents who were pregnant at the time of the
    interview or had been pregnant at least once in
    the previous 8 years were asked
  • … thinking of your (current pregnancy) (last
    pregnancy since Jan. 1993), did you see a health
    care provider to discuss pregnancy BEFORE you
    conceived, or did you wait to see a health care
    provider when you thought you were pregnant?
  • Answers
  • Before
  • Waited
  • Dont know/Not sure/Refused

7
Methods Survey Questions
  • Hispanic origin and acculturation
  • Answered Hispanic to What is your ethnicity?.
  • In terms of your daily habits and how you
    identify yourself, would you say that you are
  • Mexican
  • Chicano
  • Mexican American
  • Central American
  • South American
  • Spanish American, Latin American, Hispanic
    American
  • Anglo American

8
Methods Survey Questions
  • Experience with children affected by birth
    defects or prematurity
  • Do you know anyone who has given birth to a child
  • -with a birth defect?
  • -who was born premature or with low birth
    weight?
  • Have you ever given birth to a child
  • -with a birth defect?
  • -who was born premature or with low birth
    weight?

9
Methods Analysis
  • Responses stratified by
  • Age at time of interview
  • Race ethnicity
  • Socioeconomic characteristics
  • Education at time of interview
  • Income at time of interview
  • Acculturation
  • Parity
  • Experience with children affected by birth
    defects or prematurity
  • Statistical methods
  • Data were analyzed using SUDAAN statistical
    program
  • Logistic regression models fitted to examine
    crude association between socio-demographic
    characteristics and whether women reported
    preconception care

10
Results
  • Overall, one-third of women reported having
    preconception care with their current or most
    recent pregnancy.
  • Women were more likely to report preconception
    care if they were
  • Older
  • White
  • Household income of 50,000
  • Among Hispanic women, Mexican-American identity
    (compared to Mexican)

11
Prevalence of Preconception Care Ethnicity
34.8-54.8
15.4-28.8
12.7-31.7
Statistically significant at 95 CI compared to
both other groups.
12
Prevalence of Preconception Care Hispanic
Acculturation
18.8-46.1
9.17-29.9
Not statistically significant at 95 CI.
13
Prevalence of Preconception Care Age at Time of
Interview
31.0-61.4
27.7-45.0
12.6-28.3
Statistically significant at 95 CI compared to
18-24 age group.
14
Prevalence of Preconception Care Household
Income at Time of Interview
46.2-71.1
20.6-39.2
6.7-21.7
Statistically significant at 95 CI compared to
both other groups.
15
Prevalence of Preconception Care Education at
Time of Interview
38.8-61.2
20.7-36.2
8.2-27.5
Statistically significant at 95 CI compared to
both other groups.
16
Prevalence of Preconception Care Parity
29.1-55.5
16.0-66.5
22.8-42.7
13.2-40.6
Differences not statistically significant at 95
CI.
17
Prevalence of Preconception Care Source of
Information
Statistically significant at 95 CI compared to
clinic/ doctor/nurse category.
18
Prevalence of Preconception Care Know about
Folic Acid
29.2-43.9
18.3-34.7
Statistically significant at 95 CI.
19
Predictors of Preconception Care Age at Time of
Interview
20
Predictors of Preconception Care Ethnicity
21
Predictors of Preconception Care Education at
Time of Interview
22
Predictors of Preconception Care Household
Income at Time of Interview
23
Conclusions
  • About 1/3 of all respondents indicated that they
    had received preconception care.
  • Predictive of preconception care
  • Greater maternal age (age at time of survey)
  • Greater educational attainment
  • White ethnicity
  • Household income of 50,000
  • Among Hispanic women, Mexican-American identity
    (compared to Mexican)

24
Conclusions
  • Not predictive of preconception care
  • Personal experience with a premature baby or baby
    with birth defects
  • Parity

25
Discussion
  • Understanding socioeconomic, age and cultural
    differences can help improve the design, delivery
    and promotion of preconception care services.
  • Why are these factors associated with
    preconception care?
  • Are there differences between these patterns and
    those of other healthy behaviors?

26
Strengths/Limitations
  • Strengths
  • Large sample size
  • Response rate of 80
  • Diverse population
  • Information on multiple socio-demographics
    characteristics
  • Limitations
  • Telephone survey
  • Questions not field tested or validated
  • Small numbers in some of the multivariate
    analyses
  • Do not know age, education, or income at time of
    pregnancy
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