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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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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ResultsHealth Concerns by Race/Ethnicity
*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
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ResultsHealth Concerns by Race/Ethnicity
*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
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
12
0
10
20
30
40
50
60
High Blood Sugar (Diabetes)
Per
cent
age
ResultsMissed Opportunities
22
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
22
0
10
20
30
40
50
60
Under/Overweight
Per
cent
age
ResultsMissed Opportunities
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ResultsMissed Opportunities
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
23
0
10
20
30
40
50
60
High Blood Pressure (Hypertension)
Per
cent
age
24
ResultsMissed Opportunities
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
26
0
10
20
30
40
50
60
Under/Overweight
Per
cent
age
25
ResultsMissed Opportunities
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
38
0
10
20
30
40
50
60
No Multivitamin/Folic Acid
Per
cent
age
26
ResultsMissed Opportunities
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
43
0
10
20
30
40
50
60
Anxiety/ Depression
Per
cent
age
27
ResultsMissed Opportunities
Percentage of Women Who Reported Health Concern and Did Not Recieve Advice during Preconception Care Visit
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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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]
Further Information