Predictors of Preconception Care and Birth Defects Prevention

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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

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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.

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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

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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

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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

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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

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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

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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?

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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

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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)

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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.
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Prevalence of Preconception Care Hispanic
Acculturation
18.8-46.1
9.17-29.9
Not statistically significant at 95 CI.
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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.
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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.
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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.
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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.
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Predictors of Preconception Care Age at Time of
Interview
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Predictors of Preconception Care Ethnicity
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Predictors of Preconception Care Education at
Time of Interview
20
Predictors of Preconception Care Household
Income at Time of Interview
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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)

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Conclusions

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

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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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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?