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 Women’s 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

5. Texas Women’s 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

6. 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 Don’t know/Not sure/Refused Methods: Survey Questions

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. 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 Methods: Analysis

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. Predictors of Preconception Care: Age at Time of Interview

18. Predictors of Preconception Care: Ethnicity

19. Predictors of Preconception Care: Education at Time of Interview

20. Predictors of Preconception Care: Household Income at Time of Interview

21. 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)

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

23. 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 Strengths/Limitations

24. 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?