Content of Preconception Care - Department of...

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Content of Preconception CareFindings from the 2007 Los Angeles Mommy and Baby (LAMB) Survey

Angie Denisse Otiniano, MPH, Eunice Muthengi, MPH, MSW, Karen M. Coller, MPH PhD, Luu Cortes Doan, Fathima Wakeel, PhD, Michael C. Lu, MD, MPH,

Margaret Chao, PhD, MPH, Cynthia Harding, MPH, Chandra Higgins, MPH, Marian Eldahaby, Giannina M. Donatoni, PhD, MT(ASCP), Yvonne Y. Lau,

MPH, RD, Erin Rains and Diana E. Ramos, MD, MPH APHA

Improving pregnancy outcomes using a life course perspective: Stepping outside traditional prenatal care borders

APHA 2008- San Diego, CA

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Angie Denisse Otiniano

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

No relationships to disclose.

Presenter Disclosures

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Overview

• Significance• Theoretical Framework• Objective• Methods• Results• Limitations• Public Health Implications

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Significance

• Prenatal care is sometimes too late to prevent adverse pregnancy outcomes

• Interest in preconception care• Low preconception care utilization

– Few studies have examined the content of preconception care

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Theoretical Framework

Ecological Model

Life Course Perspective

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Objective

To examine preconception health and care among women of diverse backgrounds in Los Angeles County.

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MethodsStudy Design

• Mixed mode data collection methodology similar to PRAMS

• Multistage clustered design

• Data collected for the 2007 birth cohort

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MethodsVariablesPreconception care utilization

“During the six months before you got pregnant with your new baby, did you talk to a doctor, nurse or other health care worker about how to prepare for a healthy pregnancy and baby?”

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MethodsVariablesPreconception care content

“Think about the times you saw a doctor or nurse in the six months before you got pregnant. Did your provider talk to you about these topics to get you ready for pregnancy?”

Lead exposure and/or mercuryTaking care of your blood pressure

Genetic screeningTaking care of your blood sugar

Birth controlStop smokingAnxiety or depressionNutritionDomestic violenceImmunizationsTaking care of your gums and teethHealthy weight for pregnancy

Taking care of your medical conditions (e.g. asthma, anemia)

Multivitamin or folic acid supplements

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MethodsVariablesPreconception health status

“In the six months before you got pregnant, did you have any of these problems? Check all that apply.”

Additional questions on cigarette and vitamin usage, as well as height and weight were included to calculate Body Mass Index (BMI)

Anemia

Eat less than you felt you should because there wasn’t enough money to buy food

High blood sugar

AsthmaHigh blood pressure

Problems with your gums or teethAnxiety

Heart problemsDepression

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MethodsData AnalysisPearson’s chi square tests used to

determine if:– Preconception health status varied by

race/ethnicity– Preconception care content varied by

preconception health status

N=1,258

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ResultsOverall Utilization

Overall Preconception Care Utilization of All LAMB Respondents

30

70

0

10

20

30

40

50

60

70

80

Yes No

Preconception Care Utilization

Perc

enta

ge

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ResultsUtilization by Race/Ethnicity

*p<0.0001

Preconception Care Utilization by Race/Ethnicity

24

30

36

40

0

5

10

15

20

25

30

35

40

45

Latina Black Asian White

Perc

enta

ge

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ResultsPreconception Care Content*

*Among women who reported preconception care utilization.

Preconception Care Content

32

36

39

44

52

54

56

70

81

86

0 10 20 30 40 50 60 70 80 90 100

Medical conditions

Immunizations

Anxiety/depression

Gums and teeth

Blood pressure

Smoking cessation

Blood sugar

Healthy weight for pregnancy

Nutrition

Multivitamin/folic acid

Percentage

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ResultsPreconception Health Status and Behavior

Preconception Health Status and Behavior

4

4

11

13

15

22

47

53

0 5 10 15 20 25 30 35 40 45 50 55 60

High blood sugar

High blood pressure

Smoking

Gum or teeth problems

Anemia

Anxiety or depression

Underweight or overweight

No multivitamin/ folic acid

Percentage

16*p<0.001

ResultsHealth Concerns by Race/Ethnicity

Body Mass Index by Race/Ethnicity

5 6 414

6149 47

68

3445 49

19

0

10

20

30

40

50

60

70

80

90

100

White Black Latina Asian

Race/Ethnicity

BM

I Pe

rcen

tage Overweight

NormalUnderweight

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*p<0.001

Anemia Prevalence by Race/Ethnicity

8

26

15

10

0 5 10 15 20 25 30

White

Black

Latina

Asian

Race

/Eth

nici

ty

Percent reporting Anemia

18


*p<0.001

Multivitamin/Folic Acid use by Race/Ethnicity

64

50

37

55

0 10 20 30 40 50 60 70

White

Black

Latina

Asian

Rac

e/Et

hnic

ity

Percent taking multivitamin/folic acid

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ResultsContent by Health Status and Behavior

*p<0.001, **p<0.005, ***p<0.05, ****p<0.0001

Preconception Care Content by Preconception Health Status

9488

77

57

74

50

78

6252 52 49

33

65

41

8193

0102030405060708090

100

Smoking*

Blood Sugar**

Blood pressure***

Anxiety/Depression*

Healthy weight

Gums or teethNutritio

n

Multivitamin/folic acid****

Preconception health concern?

Perc

enta

ge

Yes No

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ResultsMissed Opportunities

Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit

6

0

10

20

30

40

50

60

Smoking

Per

cent

age

21


12

0

10

20

30

40

50

60

High Blood Sugar (Diabetes)

Per

cent

age


22


22

0

10

20

30

40

50

60

Under/Overweight

Per

cent

age


23



23

0

10

20

30

40

50

60

High Blood Pressure (Hypertension)

Per

cent

age

24



26

0

10

20

30

40

50

60

Under/Overweight

Per

cent

age

25



38

0

10

20

30

40

50

60

No Multivitamin/Folic Acid

Per

cent

age

26



43

0

10

20

30

40

50

60

Anxiety/ Depression

Per

cent

age

27



50

0

10

20

30

40

50

60

Gums or teeth

Per

cent

age

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ResultsSummary• Overall low rates of preconception care

utilization

• Preconception health status varied byrace/ethnicity

• Preconception care content varied by preconception health status and behaviors

• Missed opportunities in preconception care

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• Self Report

• Time Order

• Measure of Preconception Care

Limitations

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Public Health Implications

• Address missed opportunities

• Address overall low rates of preconception care utilization

• Additional research on preconception care and content

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Acknowledgements

Los Angeles County Public Health DepartmentMargaret Chao, Cindy Harding, Gina Donnatoni,

Yvonne Lau, Chandra Higgins, Marian Eldahaby, Karen Coller, Diana Liu, Cathleen Bemis, Carmen Gutierrez, Yvornia Horton, Martha Martinez

University of California Los AngelesMichael Lu, Eunice Muthengi, Fathima Wakeel,

Erin Rains, Luu Cortes Doan

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For further information, please visit www.LALamb.org

Contact [email protected]

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