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Martins KC, Gjelsvik A, Monteiro K. The Association Between ACE Score and Having Pre-Pregnancy Health Conversations with a Healthcare Provider (2016-2020). Matern Child Health J 2024:10.1007/s10995-024-03976-6. [PMID: 39152362 DOI: 10.1007/s10995-024-03976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES Adverse Childhood Experiences (ACEs) increase health risks leading to negative pregnancy outcomes, thus prompting the need for preconception care to address these risks. The aim of this study is to assess the association between ACEs score and self-report of having pre-pregnancy health conversations with a healthcare provider. METHODS Secondary analysis of PRAMS data from 2016 to 2020 was performed from 3 states and Washington, DC. ACEs score was categorized as 0 (low risk), 1-3 (intermediate risk), and ≥ 4 (high risk). Pre-pregnancy health conversations were measured using reports of being asked about the desire to have children, use birth control to prevent pregnancy, and/or improve health during any visit in the 12 months prior to pregnancy. Multivariate Poisson Regression was performed to adjust for potential confounders: age, race/ethnicity, income, education, insurance type, marital status, pregnancy intention, and parity. RESULTS A total of 10,448 PRAMS survey responses from 2016 to 2020 were included in the analysis. More than half of women reported having at least 1 ACE (51%). Those with an ACE score of ≥ 4 had 1.19 (95% CI: 1.01-1.41) times higher adjusted Prevalence Ratio (aPR) and those with an ACE score of 1-3 had about the same aPR 1.00 (95% CI: 0.93-1.09) of reporting pre-pregnancy health conversations with a healthcare provider compared to those with no ACEs. CONCLUSIONS FOR PRACTICE: The overall low percentage of respondents reporting receipt of pre-pregnancy health conversations with a health care provider indicates the need for these conversations to be had on a more routine basis.
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Affiliation(s)
- Kyana C Martins
- School of Public Health, Brown University, Providence, Rhode Island, USA.
| | - Annie Gjelsvik
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Karine Monteiro
- Rhode Island Department of Health, Providence, Rhode Island, USA
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Sajjadian F, Amiri-Farahani L, Haghani S, Pezaro S. Investigating the relationship between health literacy and preconceptual care components during the first 14 weeks of pregnancy: a cross-sectional study. BMC PRIMARY CARE 2024; 25:209. [PMID: 38862877 PMCID: PMC11165771 DOI: 10.1186/s12875-024-02467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND AND AIM Preconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptual care, this study aimed to determine the relationship between health literacy and receiving components of preconceptual care prior to pregnancy. METHODS This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling was done from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via proportional allocation method. The data collection tool comprised a questionnaire consisting of 3 parts: (1) individual and fertility characteristics, (2) information related to the components of preconceptual care and (3) health literacy for Iranian adults. This was completed by individual participants via the self-reporting method. RESULTS The majority of participants were between 30 and 34 years old. They also identified as women with a university education and were predominantly unemployed. The mean health literacy of participants was 76.81%. Health literacy obtained the highest mean score in the dimension of 'understanding' and the lowest mean score in the dimension of 'access'. The frequency of preconceptual counseling, folic acid supplement consumption, exercise, blood testing, dental visits, genetic counseling, Pap smear testing and rubella, diphtheria, and hepatitis vaccinations prior to pregnancy was 66.8%, 53.8%, 45.6%, 71.86%, 44.44%, 12%, 53.4%, 10.83%, respectively. Many (> 64%) received preconceptual care at specialist gynecology offices. Results demonstrated that health literacy had a statistically significant relationship with preconceptual care, folic acid consumption, exercise and dental care, (p < 0.001), along with blood testing and Pap smear testing (p < 0.05). CONCLUSION Overall, our results demonstrate that despite health literacy being optimal, uptakes of some components of preconceptual care are low. As such, it will be important to further raise awareness of the importance of preconceptual care for people prior to pregnancy as a priority in health promotion and education.
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Affiliation(s)
- Fatemeh Sajjadian
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Notre Dame, Australia
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Cameron NA, Everitt IK, Lee KA, Yee LM, Khan SS. Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention. Hypertension 2023; 80:1162-1170. [PMID: 36960717 PMCID: PMC10192076 DOI: 10.1161/hypertensionaha.122.19317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine (N.A.C.), Northwestern University Feinberg School of Medicine
| | - Ian K Everitt
- Department of Medicine, Division of Hospital Medicine (I.K.E.), Northwestern University Feinberg School of Medicine
| | - Kristen A Lee
- Department of Medicine, McGaw Medical Center of Northwestern University (K.A.L.)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (L.M.Y.), Northwestern University Feinberg School of Medicine
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology (S.S.K.), Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine (S.S.K.), Northwestern University Feinberg School of Medicine
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Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum. Obstet Gynecol 2023; 141:570-581. [PMID: 36735410 PMCID: PMC9928561 DOI: 10.1097/aog.0000000000005081] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents. METHODS We performed a pooled, cross-sectional analysis of survey data from 154,992 postpartum individuals in 43 states and two jurisdictions that participated in the 2016-2019 PRAMS (Pregnancy Risk Assessment Monitoring System). We calculated unadjusted estimates of insurance coverage (Medicaid, commercial, or uninsured) during three periods (prepregnancy, birth, and postpartum), as well as insurance continuity across these periods among rural and urban U.S. residents. We conducted subgroup analyses to compare uninsurance rates among rural and urban residents by sociodemographic and clinical characteristics. We used logistic regression models to generate adjusted odds ratios (aORs) for each comparison. RESULTS Rural residents experienced greater odds of uninsurance in each period and continuous uninsurance across all three periods, compared with their urban counterparts. Uninsurance was higher among rural residents compared with urban residents during prepregnancy (15.4% vs 12.1%; aOR 1.19, 95% CI 1.11-1.28], at birth (4.6% vs 2.8%; aOR 1.60, 95% CI 1.41-1.82), and postpartum (12.7% vs 9.8%, aOR 1.27, 95% CI 1.17-1.38]. In each period, rural residents who were non-Hispanic White, married, and with intended pregnancies experienced greater adjusted odds of uninsurance compared with their urban counterparts. Rural-urban differences in uninsurance persisted across both Medicaid expansion and non-expansion states, and among those with varying levels of education and income. Rural inequities in perinatal coverage were experienced by Hispanic, English-speaking, and Indigenous individuals during prepregnancy and at birth. CONCLUSION Perinatal uninsurance disproportionately affects rural residents, compared with urban residents, in the 43 states examined. Differential insurance coverage may have important implications for addressing rural-urban inequities in maternity care access and maternal health.
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Nishat F, Lunsky Y, Tarasoff LA, Brown HK. Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study. Disabil Health J 2022; 15:101322. [PMID: 35440405 PMCID: PMC9743244 DOI: 10.1016/j.dhjo.2022.101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/19/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Women with disabilities experience elevated risks for pregnancy complications and report barriers accessing prenatal care. Emerging evidence highlights the significant role primary care providers play in promoting preventive services like prenatal care. OBJECTIVE To examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities. METHODS We conducted a population-based study using health administrative data in Ontario, Canada. The study population included 15- to 49-year-old women with physical (n = 106,555), sensory (n = 32,194), intellectual/developmental (n = 1515), and multiple (n = 6543) disabilities who had a singleton livebirth or stillbirth in 2003-2017 and ≥ 3 primary care visits < 2 years before conception. COC was measured using the Usual Provider of Care Index. Nominal logistic regression was used to compute adjusted odds ratios (aOR) for prenatal care adequacy, measured using the Revised-Graduated Prenatal Care Utilization Index, for women with low versus moderate/high COC, controlling for other social and medical characteristics. RESULTS Women with disabilities with low COC, versus those with moderate/high COC, had increased odds of no (aOR 1.42, 95% CI 1.29-1.56), inadequate (aOR 1.19, 95% CI 1.16-1.23), and intensive prenatal care (aOR 1.22, 95% CI 1.19-1.25) versus adequate. In additional analyses, women with low COC and no/inadequate prenatal care were the most socially disadvantaged among the cohort, and those with low COC and intensive prenatal care had the greatest medical need. CONCLUSION Improving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access.
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Affiliation(s)
- Fareha Nishat
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health: 155 College St, Toronto, Ontario, Canada M5T 3M7; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5
| | - Yona Lunsky
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health: 155 College St, Toronto, Ontario, Canada M5T 3M7; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4,Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4; Department of Health & Society: 1265 Military Trail, Toronto, Ontario, Canada, M1C 1A5
| | - Hilary K. Brown
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health: 155 College St, Toronto, Ontario, Canada M5T 3M7; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5,Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4; Department of Health & Society: 1265 Military Trail, Toronto, Ontario, Canada, M1C 1A5
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Coverage Effects of the ACA's Medicaid Expansion on Adult Reproductive-Aged Women, Postpartum Mothers, and Mothers with Older Children. Matern Child Health J 2022; 26:1104-1114. [PMID: 35249171 PMCID: PMC8898501 DOI: 10.1007/s10995-022-03384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/10/2022]
Abstract
Objectives We estimate the effect of the Affordable Care Act’s (ACA) Medicaid expansions on Medicaid coverage of reproductive-aged women at varying childbearing stages. Methods Using data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women without children, postpartum mothers, and mothers of children older than one year in expansion states to non-expansion states, before and after the expansions. Results The ACA’s Medicaid expansion increased Medicaid coverage among adult women with incomes between 101 and 200% of the federal poverty line (FPL) without children by 10.7 percentage points (54 percent, p < 0.01). Coverage of mothers with children older than one year increased by 9.5 percentage points (34 percent, p < 0.01). Coverage of mothers with infants rose by 7.9 percentage points (21 percent, p < 0.01). Conclusions for Practice Within the population of adult reproductive-aged women, we find a “fanning out” of effects from the ACA’s Medicaid expansions. Childless women experience the largest gains in coverage while mothers of infants experience the smallest gains; mothers of children greater than one year old fall in the middle. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.
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Moore MD, Mazzoni SE, Wingate MS, Bronstein JM. Characterizing Hypertensive Disorders of Pregnancy Among Medicaid Recipients in a Nonexpansion State. J Womens Health (Larchmt) 2022; 31:261-269. [PMID: 34115529 PMCID: PMC8864437 DOI: 10.1089/jwh.2020.8741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: The incidence of hypertensive disorders of pregnancy (HDP) are on the rise in the United States, especially in the South, which has a heavy chronic disease burden and large number of Medicaid nonexpansion states. Sizeable disparities in HDP outcomes exist by race/ethnicity, geography, and health insurance coverage. Our objective is to explore HDP in the Alabama Medicaid maternity population, and the association of maternal sociodemographic, clinical, and care utilization characteristics with HDP diagnosis. Materials and Methods: Data were from Alabama Medicaid delivery claims in 2017. Bivariate analyses were used to examine maternal characteristics by HDP diagnosis. Hierarchical generalized linear models, with observations nested at the county level, were used to assess multivariable relationships between maternal characteristics and HDP diagnosis. Results: Among women with HDP diagnosis, a higher proportion were older, Black, had other comorbidities, and had more perinatal hospitalizations or emergency visits compared with those without HDP diagnosis. There were increased odds of an HDP diagnosis for older women and those with comorbidities. Black women (adjusted odds ratio [aOR] = 1.24, 95% confidence interval [CI]: 1.16-1.33), women insured only during pregnancy by Sixth Omnibus Reconciliation Act Medicaid (aOR = 1.08, 95% CI: 1.02-1.15), and women entering prenatal care (PNC) in the second trimester (aOR = 1.10, 95% CI: 1.03-1.18) had elevated odds of HDP diagnosis compared with their counterparts. Conclusions: Beyond traditional demographic and clinical risk factors, not having preconception insurance coverage or first trimester PNC entry were associated with higher odds of HDP diagnosis. Improving the provision and timing of maternity coverage among Medicaid recipients, particularly in nonexpansion states, may help identify and treat women at risk of HDP and associated adverse perinatal outcomes.
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Affiliation(s)
- Matthew D. Moore
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara E. Mazzoni
- Department of Obstetrics and Gynecology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martha S. Wingate
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet M. Bronstein
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Testa A, Jackson DB, Ganson KT, Nagata JM. Maternal adverse childhood experiences and pregnancy intentions. Ann Epidemiol 2021; 64:47-52. [PMID: 34547446 DOI: 10.1016/j.annepidem.2021.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/20/2021] [Accepted: 09/14/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The current study investigates the association between maternal adverse childhood experiences (ACEs) and having an unwanted (i.e., a pregnancy that was undesired) or mistimed pregnancy (i.e., a pregnancy that occurred sooner than wanted). METHODS Data are from the 2018 North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 1897). Multinomial logistic regression analyses are used to assess the association between levels of ACE exposure and having an unwanted or mistimed pregnancy relative to an intended pregnancy. RESULTS Findings demonstrated that women with three ACEs (Relative Risk Ratio [RRR] = 2.157, 95% confidence interval [CI], 1.121-4.151) and four or more ACEs (RRR = 1.836, 95% CI, 1.181-2.854) had approximately twice the relative risk of having an unwanted pregnancy (vs. an intended pregnancy) compared to women with 0 ACEs. There was no association between ACEs and reporting a mistimed pregnancy. CONCLUSIONS These findings add to a burgeoning literature detailing how accumulating ACEs can create challenges for family planning by increasing the likelihood of having an unintended pregnancy. Study results suggest the need to devote greater resources to the prevention of ACEs and unintended pregnancies.
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Affiliation(s)
- Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio.
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Jason M Nagata
- Department of Pediatrics, University of California San Francisco
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Alberti A, Traebert J, Traebert E, Nodari Junior RJ, Comim CM. Association between gestational period and obesity in children with the use of dermatoglyphic traits: A preliminary study. PLoS One 2021; 16:e0257153. [PMID: 34499696 PMCID: PMC8428559 DOI: 10.1371/journal.pone.0257153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022] Open
Abstract
Events occurring during the gestational period can influence the development of diseases and conditions such as obesity. This study aimed to analyze the association between events occurring in the gestational period and the occurrence of obesity in children based on dermatoglyphic traits. The sample comprised 73 children born in 2009, living in Palhoça, Santa Catarina (SC), Brazil, regularly enrolled in public and private schools in that municipality and who are participants of an ongoing major cohort study project called Coorte Brasil Sul. The results show predictive traits of obesity when comparing BMI and fingerprint groups. Obese male group, presented the figure Ulnar Loop (UL) in the right hand (MDT1) thumb and greater number of ridges in the (MDSQL1) right thumb the greater the BMI; likewise, the older the woman getting pregnant the greater the number of ridges that the child presented in the (MESQL2) left index finger and (MESQL1) right thumb. The results obtained infer the presence of predictive traits of BMI ranges and a possible association between the dermatoglyphic traits of children with obesity and late pregnancy women.
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Affiliation(s)
- Adriano Alberti
- Postgraduate Program in Health Sciences, Southern University of Santa Catarina (PPGCS-UNISUL), Palhoça, Santa Catarina, Brazil
| | - Jefferson Traebert
- Postgraduate Program in Health Sciences, Southern University of Santa Catarina (PPGCS-UNISUL), Palhoça, Santa Catarina, Brazil
| | - Eliane Traebert
- Postgraduate Program in Health Sciences, Southern University of Santa Catarina (PPGCS-UNISUL), Palhoça, Santa Catarina, Brazil
| | - Rudy José Nodari Junior
- Postgraduate program in Biosciences and Health at University of the West of Santa Catarina, Joaçaba, Santa Catarina, Brazil
| | - Clarissa Martinelli Comim
- Postgraduate Program in Health Sciences, Southern University of Santa Catarina (PPGCS-UNISUL), Palhoça, Santa Catarina, Brazil
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Quinn DA, Edmonds SW, Zhao X, Borrero S, Ryan GL, Zephyrin LC, Callegari LS. Veteran-Reported Receipt of Prepregnancy Care: Data from the Examining Contraceptive Use and Unmet Need (ECUUN) Study. Matern Child Health J 2021; 25:1254-1264. [PMID: 33929654 PMCID: PMC11220786 DOI: 10.1007/s10995-021-03131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify the prevalence of women Veterans reporting receipt of counseling about health optimization prior to pregnancy, topics most frequently discussed, and factors associated with receipt of this care. METHODS We analyzed data from a nationally representative, cross-sectional telephone survey of women Veterans (n = 2302) ages 18-45 who used VA for primary care in the previous year. Our sample included women who were (1) currently pregnant or trying to become pregnant, (2) not currently trying but planning for pregnancy in the future, or (3) unsure of pregnancy intention. Multivariable logistic regression was used to examine adjusted associations of patient- and provider-level factors with receipt of any counseling about health optimization prior to pregnancy (prepregnancy counseling) and with counseling on specific topics. RESULTS Among 512 women who were considering or unsure about pregnancy, fewer than half (49%) reported receiving any prepregnancy counseling from a VA provider in the past year. For those who did, the most frequently discussed topics included healthy weight (29%), medication safety (27%), smoking (27%), and folic acid use before pregnancy (27%). Factors positively associated with receipt of prepregnancy counseling include history of mental health conditions (aOR = 1.96, 95% CI: 1.28, 3.00) and receipt of primary care within a dedicated women's health clinic (aOR = 2.07, 95% CI: 1.35, 3.18), whereas factors negatively associated include far-future and unsure pregnancy intentions (aOR = 0.35, 95% CI: 0.17, 0.71 and aOR = 0.33, 95% CI: 0.16, 0.70, respectively). CONCLUSIONS FOR PRACTICE Routine assessment of pregnancy preferences in primary care could identify individuals to whom counseling about health optimization prior to pregnancy can be offered to promote patient-centered family planning care.
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Affiliation(s)
- Deirdre A Quinn
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building #30, Pittsburgh, PA, 15240, USA.
| | - Stephanie W Edmonds
- Office of Nursing Research and Evidence-Based Practice, University of Iowa Health Care, Iowa City, Iowa, USA
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building #30, Pittsburgh, PA, 15240, USA
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building #30, Pittsburgh, PA, 15240, USA
- Center for Research On Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Lisa S Callegari
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
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Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens. J Adolesc Health 2021; 69:315-320. [PMID: 33483235 DOI: 10.1016/j.jadohealth.2020.12.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/21/2020] [Accepted: 12/13/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy. METHODS A continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18 months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth, miscarriage, termination), and continuity with a single clinician. Demographic factors included age, race, ethnicity, primary insurance, and residential zip code. Logistic regression identified factors associated with visits after pregnancy. Separately, for a cohort of 47 parenting teens who received primary care at the same site as their infants, we assessed teen-infant care after birth. RESULTS Teens were predominantly non-Latina black (91%) and Medicaid insured (71%). Before pregnancy, most teens had preventive visits (66%) and reported contraceptive use (65%). After pregnancy, 52% discussed pregnancy decisions within a month, 55% reported contraceptive use, and 64% had any primary care visit. Postpregnancy visits were associated with teen age (<18 vs. ≥18 years odds ratio 2.84, 95% confidence interval 1.17-6.90) and pregnancy outcome (termination vs. live birth odds ratio 4.02, 95% confidence interval 1.47-11.01). Among parenting teens, there were more infant visits than teen visits, and continuity was higher for infants. CONCLUSION In a primary care cohort of pregnant teens, gaps persisted in pediatric clinical follow-up after pregnancy. Particularly in situations where pregnancy led to a birth, pregnancy frequently prompted a transition away from pediatric care.
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Haviland MJ, Nillni YI, Fox MP, Savitz DA, Hatch EE, Rothman KJ, Hacker MR, Wang TR, Wise LA. Psychotropic medication use during pregnancy and gestational age at delivery. Ann Epidemiol 2020; 53:34-41.e2. [PMID: 32835770 DOI: 10.1016/j.annepidem.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the association between psychotropic medication use during pregnancy and gestational age at delivery, after adjusting for depressive symptom and perceived stress severity. METHODS We analyzed data on singleton live births from 2914 female Pregnancy Study Online participants, aged 21 to 45, with a reported conception from 6/2013 to 6/2018. Women reported psychotropic medication use at 8 to 12 weeks' and ~32 weeks' gestation. We measured depressive symptoms using the Major Depressive Inventory and perceived stress using the 10-item Perceived Stress Scale. Data on gestational age at delivery were based on self-reports and/or birth certificates. We used restricted mean survival time models, stratifying by severity of depressive symptoms (Major Depression Inventory <25 vs. ≥25) and perceived stress (Perceived Stress Scale <20 vs. ≥20). RESULTS Two hundred and ten (7.2%) participants reported using psychotropic medications during pregnancy. Mean gestational age at delivery among women who never used psychotropic medications was 38.2 weeks (95% confidence interval: 37.7, 38.7), whereas it was 37.3 weeks (95% confidence interval: 36.7, 37.9) among women who used psychotropic medications during pregnancy. Results were similar across strata of depressive symptoms and perceived stress. CONCLUSIONS Our data indicate that the association between psychotropic medication use and gestational age at delivery is not confounded by indication.
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Affiliation(s)
- Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA; National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; RTI International, Research Triangle Park, NC
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103702. [PMID: 32456323 PMCID: PMC7277238 DOI: 10.3390/ijerph17103702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
Preconception care (PCC) is acknowledged as a vital preventive health measure aiming to promote health today and for subsequent generations. We aimed to describe the content and context of PCC delivery in a very remote Australian Aboriginal Community Controlled Health Service setting. A retrospective audit was undertaken to identify what PCC was delivered between 2011 and 2018 to 127 Aboriginal women who had at least one pregnancy during this period. Of 177 confirmed pregnancies, 121 had received PCC prior to the pregnancy. Sexually transmissible infection screening (71%) was the most common care delivered, followed by folic acid prescription (57%) and smoking cessation support (43%). Younger women received PCC less often, particularly screening for modifiable pregnancy risk factors. Rates of prediabetes/diabetes, albuminuria, overweight/obesity and smoking were high amongst those screened (48-60%). PCC was usually patient-initiated and increased significantly over the audit period. Presentation for antenatal care in the first trimester of pregnancy was high at 73%. Opportunities to increase PCC delivery include integration with routine health checks, pregnancy tests and chronic disease programs. PCC programs codesigned with young people are also recommended. All primary care providers should be supported and assisted to provide opportunistic PCC and health promotion.
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Abstract
OBJECTIVE To estimate the effects of the Affordable Care Act Medicaid expansion provision that was largely implemented in 2014 on preconception insurance coverage among low-income women. METHODS We used a quasiexperimental, difference-in-difference design to compare changes in preconception insurance coverage among low-income women living in expansion compared with nonexpansion states before and after the Medicaid expansions. Women with family incomes 138% the federal poverty level or less who participated in the Pregnancy Risk Assessment Monitoring System from 2009 to 2015 from states that did or did not expand their Medicaid programs on January 1, 2014, were included. The exposure of interest was the state Medicaid expansion. The primary outcome was insurance status 1 month before conception. We conducted additional subgroup and sensitivity analyses to test the assumptions of the model and the robustness of the findings. RESULTS The study sample included 30,495 women from eight states that expanded Medicaid under the Affordable Care Act and 26,561 patients from seven states in that did not. The rate of preconception Medicaid coverage was 30.8% prepolicy and 35.6% postpolicy in nonexpansion states and 43.2% prepolicy and 56.8% postpolicy in expansion states. There was a significantly greater increase in Medicaid coverage in expansion states after the policy implementation (adjusted difference-in-difference estimate +8.6% points, 95% CI 1.1-16.0). Rates of preconception uninsurance were 44.2% prepolicy and 34.3% postpolicy in nonexpansion states and 37.4% prepolicy and 23.5% postpolicy in expansion states. There was no significant difference in the changes in uninsurance between the two groups in the postpolicy period (adjusted difference-in-difference estimate -4.1, 95% CI -11.1 to 2.9). Non-Medicaid insurance coverage was 25.3% prepolicy and 30.5% postpolicy in nonexpansion states and 19.4% prepolicy and 19.7% postpolicy in expansion states. Relative to nonexpansion states, there was a significant decrease in non-Medicaid coverage in the expansion states in the postpolicy period (adjusted difference-in-difference estimate -4.7, 95% CI -8.3 to -1.1). The results were robust to alternate model specifications and study period definitions. CONCLUSION Medicaid expansion was associated with increased enrollment in Medicaid before pregnancy among low-income women; however, there were no changes in the rates of uninsurance. Additional years of postpolicy data are needed to fully assess the effects of the policy change.
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Daw JR, Sommers BD. The Affordable Care Act and Access to Care for Reproductive-Aged and Pregnant Women in the United States, 2010-2016. Am J Public Health 2019; 109:565-571. [PMID: 30789761 DOI: 10.2105/ajph.2018.304928] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate the association between the Affordable Care Act (ACA), health insurance coverage, and access to care among reproductive-aged and pregnant women. METHODS We performed an observational study comparing current insurance type, cost-related barriers to medical care, and no usual source of care among reproductive-aged (n = 128 352) and pregnant (n = 2179) female respondents to the National Health Interview Survey in the United States, before (2010-2013) and after (2015-2016) the ACA coverage expansions. RESULTS Among reproductive-aged women, the ACA was associated with a 7.4 percentage-point decrease in the probability of uninsurance (95% confidence interval [CI] = -8.6, -6.2), a 3.6 percentage-point increase in Medicaid (95% CI = 2.5, 4.7), and a 3.1 percentage-point increase in nongroup private coverage (95% CI = 2.1, 4.1). The ACA was also associated with a 1.5 percentage-point decline in cost-related barriers to medical care (95% CI = -2.6, -0.5) and a 2.4 percentage-point reduction in lacking a usual source of care (95% CI = -4.5, -0.3). We did not find significant changes in insurance or cost-related barriers to care for pregnant women. CONCLUSIONS The ACA was associated with expanded insurance coverage and improvements in access to care for women of reproductive age, particularly for those with lower incomes.
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Affiliation(s)
- Jamie R Daw
- Jamie R. Daw is with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Benjamin D. Sommers is with the Harvard T. H. Chan School of Public Health and Harvard Medical School/Brigham & Women's Hospital, Boston, MA
| | - Benjamin D Sommers
- Jamie R. Daw is with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Benjamin D. Sommers is with the Harvard T. H. Chan School of Public Health and Harvard Medical School/Brigham & Women's Hospital, Boston, MA
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Preconception insurance and initiation of prenatal care. J Perinatol 2019; 39:300-306. [PMID: 30546058 DOI: 10.1038/s41372-018-0292-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The primary objective was to determine the association between preconception insurance and initiation of prenatal care. STUDY DESIGN This retrospective cohort uses data from the Pregnancy Risk Assessment Monitoring System (2009-2013). Self-reported preconception insurance status was the primary exposure. The primary outcome was first trimester initiation of prenatal care. Secondary outcomes included: preterm delivery, birth weight, and the presence of birth defects. Survey-weighted generalized linear models were used to calculate risk ratios and accounted for state-level clustering. RESULTS Of the 181,675 included women from 32 states, 21.1% were uninsured prior to conception. 88% of insured women vs. 70% of uninsured women initiated care in the first trimester. Uninsured women were less likely to initiate care in the first trimester (adjusted relative risk (RR) 0.87 (95% confidence interval 0.85-0.89), p < 0.001) compared to women with insurance in the adjusted analysis. Among the secondary outcomes, uninsured nulliparous women had a 20% higher risk of extremely (<28 weeks) preterm delivery than those with preconception insurance (adjusted RR 1.20 (1.03-1.39), p = 0.01). Uninsured women also had a slightly increased risk of having SGA infant compared to insured women (adjusted RR 1.04 (1.01-1.09), p = 0.02). There were no differences in the other secondary outcomes. CONCLUSIONS Preconception insurance is associated with earlier initiation of prenatal care.
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Gregory EF, Wright CS, Matone M, Rubin DM, Lorch SA. Support for Self-Management and Prenatal Health Behavior Change: Implications for Pediatric Promotion of Interconception Care. Glob Pediatr Health 2018; 5:2333794X18765368. [PMID: 29623289 PMCID: PMC5882042 DOI: 10.1177/2333794x18765368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022] Open
Abstract
Pediatricians increasingly endorse a dual generation approach to health, in which parental health behaviors are recognized as critical to promoting child health. Positive parental behaviors often emerge during pregnancy, for reasons that remain incompletely described. We surveyed mothers in the immediate postpartum period to identify beliefs about health behavior change and characteristics of prenatal care associated with successful change. Sampling at a tertiary care hospital captured an English-speaking adult population with healthy infants. Respondents (n = 225) were predominantly non-Hispanic Black (64%) and Medicaid insured (44%). Most (71%) reported successful behavior change during pregnancy. Of those reporting change, 91% intended to sustain behaviors postnatally. Most believed that sustained change was important for their own health (94%) and their infant’s health (93%). In logistic regression, support for self-management was associated with prenatal health behavior change (odds ratio = 1.64, 95% confidence interval = 1.09-2.46). Continued support for self-management by pediatricians may benefit long-term family health.
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Affiliation(s)
- Emily F Gregory
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | | | - Meredith Matone
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - David M Rubin
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Scott A Lorch
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
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