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Disparities in Preconception Health Care: An Overview Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D. Senior Advisor on Women’s Health CDC National Summit on Preconception Care Atlanta, June 21-22, 2005 Prenatal Care in the United States 2000 7.6% of babies were born at ≤ 2,500 grams – LBW

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Disparities in Preconception Health Care: An Overview

Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D.

Senior Advisor on Women’s Health

CDC National Summit on Preconception Care

Atlanta, June 21-22, 2005


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Prenatal Care in the United States

  • 2000

    • 7.6% of babies were born at ≤ 2,500 grams – LBW

    • 1.4% of babies were born at ≤ 1,500 grams – VLBW

    • 7.2 infant deaths per 1,000 live births (vs. 6.9 in 1998)

    • About 83% of women had prenatal care 1st trimester

2003 NHQR/NHDR; Vital Statistics 2000


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Prenatal Care

Mothers with prenatal care in the first trimester by race, ethnicity, and education, 2000-2001

National Vital Statistics System -- Natality, 2000-2001; 2004 National Healthcare Disparities Report


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Preconception & Prenatal Care

Risk reduction

obstetric

complications

Improved

pregnancy outcomes



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Racial/ethnic minority women of child-bearing age have particularly poor access to care

MEPS 2001


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Poorer communication with health care providers particularly poor access to care

MEPS 2001


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Women’s Perception of Cultural Competency particularly poor access to care

%

2003 NHQR/NHDR


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Essential Components of Preconception Care in the Primary Care Setting

  • Risk assessment

  • Health promotion

  • Intervention


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Preconception Health Care Checklist Care Setting

  • Genetic

    • Folic acid supplement

    • Carrier screening-ethnic background: sickle cell anemia, Thalassemia, Tay-Sachs disease

    • Carrier screening –family history: cystic fibrosis, nonsyndromic hearing loss (connexin-26)


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Preconception Health Care Checklist Care Setting

  • Screening for infectious diseases, treatment, immunization, counseling:

    • HIV/AIDS

    • Hepatitis B

    • Rubella

    • Varicella

    • Toxoplasmosis

    • Cytomegalovirus

    • Parvovirus-19


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Preconception Health Care Checklist Care Setting

  • Environmental toxins:

    • Occupational exposures

    • Household chemicals

    • Smoking cessation

    • Alcohol screening

    • Illegal drug use screening


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Preconception Health Care Checklist Care Setting

  • Medical assessment:

    • Diabetes

    • Hypertension

    • Epilepsy

    • DVT

    • Depression/anxiety


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Preconception Health Care Checklist Care Setting

  • Lifestyle:

    • Screen for domestic violence

    • Exercise

    • Avoidance of hyperthermia

    • Obesity & underweight

    • Nutritional deficiencies

      • Avoidance of overuse of vitamins A and D, caffeine


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Race/Ethnicity & Genetic Risks Care Setting(Cowchick et al, 1994)


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Genetic Risks – Family History and Age Care Setting

  • Cystic fibrosis

  • Congenital hearing loss

  • Child-bearing after age 35

Brundage, 2002; Grody et al, 2001


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Folic Acid Care Setting

  • Supplementation reduces incidence of neural tube defects (spina bifida, anencephaly)

  • Average woman: 100mcg/day

  • Pregnancy: 400mcg/day, starting at least one month before pregnancy through first three months

  • Special risk groups:

    • Diabetes 1mg/day

    • Epilepsy 1mg/day

    • Prior birth with neural tube defect 4mg/day

Brundage, 2002; Grody et al, 2001


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Disparities in Preconception Care Care SettingFolic Acid

  • Hispanic women are less likely to be aware of the benefits from folic acid

  • About 1/3 of Hispanic women report taking folic acid compared to 50% of nonHispanic women between 1999-2002

  • Physicians have been increasingly reported as an important source of information about folic acid

CWHS (1997-2002)


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Disparities in Preconception Care Care SettingFolic Acid

  • Women with lower levels of education – less than high school – and lower socioeconomic power or with no health insurance are less likely to be aware of or to take folic acid

Brundage, 2002; Grody et al, 2001


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Disparities - New HIV/AIDS Cases in Women Care Setting(number of cases per 100,000 population)

HIV/AIDS Surveillance System, 2000


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Women Aged 18 and Older with Diabetes,* by Race/Ethnicity,** 2002

*Reported a health professional has ever told them they have diabetes; **rates reported are not age-adjusted; ***non-Hispanic; includes Asian/Pacific Islander, American Indian/Alaska Native, and persons of more than one race.

Rate per 1,000 Women

National Health Interview Survey, CDCP, NCHS


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Effects of Diabetes on Conception & Pregnancy 2002

  • Birth defects

    • Ventricular septal defects

    • Neural tube defects

    • Caudal regression syndrome

  • Other fetal effects

    • Macrosomia

  • Obstetric complications

    • Preeclampsia

    • Urinary tract infection

    • Premature labor


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Adults With Diabetes Who Had All Five Recommended Services 2002

  • HBA1c

  • Lipid profile

  • Retinal eye exam

  • Foot exam

  • Influenza vaccination

Hispanics

33% less likely

2004 NHQR/NHDR, 2000/2001MEPS Data


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Women 2002Diabetes

Women with diabetes who had

a retinal eye exam in the past

year by race, ethnicity, and income, 2000-2001

Medical Expenditure Panel Survey, 2000-2001; 2004 National Healthcare Disparities Report


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Overweight and Obesity* in Women Aged 18 and Older, by Age, 2002

*In the National Health Interview Survey, obesity was defined as a body mass index of 30.0 or higher. Overweight was defined as a body mass index of 25.0 or higher, including all those defined as obese.

Percent of Women

Years

National Health and Nutrition Examination Survey, CDCP, NCHS


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2002

Women Aged 18 and Older with Hypertension,* by Race/Ethnicity,*** 2002

*Respondents who reported a health professional has ever told them that they have hypertension; **rates reported are not age-adjusted; ***non-Hispanic; includes Asian/Pacific Islander, American Indian/Alaska Native, & persons of more than one race.

Rate per 1,000 Women

National Health Interview Survey, CDCP, NCHS


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Disparities in Hypertension Care 2002

  • Rates for blood pressure screening are 90% (blacks with higher rates), but only 25% of those with high blood pressure have it under control.

Current Best Practices

  • Blood pressure measurement

  • Follow-up treatment plan

NHQR/NHDR 2003; AMA 2003


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Females Age 15-44 Reporting Past Month Use of Cigarettes, by Race/Ethnicity and Pregnancy, 2002

36

31.1

% of Women

24.1

25.3

17.3

18.8

NP

7.3

P

6

Source: Substance Abuse & Mental health Administration, National on Drug Use & Health


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Final Remarks Race/Ethnicity and Pregnancy, 2002

  • Primary care clinicians should discuss with women of child-bearing age of all races and ethnicities ways to improve pregnancy outcomes

  • The effort at risk reduction involves coordinated collaboration among health care professionals

  • This collaboration should be a continuous process at each routine visit before and during pregnancy


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Final Remarks Race/Ethnicity and Pregnancy, 2002

  • Disparities in preconception care exist and may lead to poor outcomes. Hispanic women are significantly affected

  • Identification of reasons behind disparities and development of effective interventions to reduce or eliminate them are priorities.

  • Patient/provider communication may require further attention to enhance women’s awareness and provider’s cultural competence.


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Thank You! Race/Ethnicity and Pregnancy, 2002

[email protected]


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