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 Mention TORCHMention TORCH

4. 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

5. 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

6. 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 Don�t know/Not sure/Refused

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. 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 Data are weighted (adjusted) to represent the Texas population.Data are weighted (adjusted) to represent the Texas population.

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

12. Prevalence of Preconception Care: Hispanic Acculturation N=N=

13. Prevalence of Preconception Care: Age at Time of Interview

14. Prevalence of Preconception Care: Household Income at Time of Interview

15. Prevalence of Preconception Care: Education at Time of Interview

16. Prevalence of Preconception Care: Parity How many children have you given birth to?How many children have you given birth to?

17. Prevalence of Preconception Care: Source of Information

18. Prevalence of Preconception Care: Know about Folic Acid

19. Predictors of Preconception Care: Age at Time of Interview CRUDECRUDE

20. Predictors of Preconception Care: Ethnicity

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

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

23. 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) B3. In terms of your daily habits and how you identify yourself, would you say that you are (read 1-8) � 1. Mexican 2. Chicano 3. Mexican American 4. Central American 5. South American 6. Spanish American, Latin American, Hispanic American 7. Anglo American 8. Other: _____________________________ B3. In terms of your daily habits and how you identify yourself, would you say that you are (read 1-8) � 1. Mexican 2. Chicano 3. Mexican American 4. Central American 5. South American 6. Spanish American, Latin American, Hispanic American 7. Anglo American 8. Other: _____________________________

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

25. 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?

26. 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