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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

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
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

prenatal care
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

preconception prenatal care
Preconception & Prenatal Care

Risk reduction

obstetric

complications

Improved

pregnancy outcomes

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

MEPS 2001

essential components of preconception care in the primary care setting
Essential Components of Preconception Care in the Primary Care Setting
  • Risk assessment
  • Health promotion
  • Intervention
preconception health care checklist
Preconception Health Care Checklist
  • 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)
preconception health care checklist11
Preconception Health Care Checklist
  • Screening for infectious diseases, treatment, immunization, counseling:
    • HIV/AIDS
    • Hepatitis B
    • Rubella
    • Varicella
    • Toxoplasmosis
    • Cytomegalovirus
    • Parvovirus-19
preconception health care checklist12
Preconception Health Care Checklist
  • Environmental toxins:
    • Occupational exposures
    • Household chemicals
    • Smoking cessation
    • Alcohol screening
    • Illegal drug use screening
preconception health care checklist13
Preconception Health Care Checklist
  • Medical assessment:
    • Diabetes
    • Hypertension
    • Epilepsy
    • DVT
    • Depression/anxiety
preconception health care checklist14
Preconception Health Care Checklist
  • Lifestyle:
    • Screen for domestic violence
    • Exercise
    • Avoidance of hyperthermia
    • Obesity & underweight
    • Nutritional deficiencies
      • Avoidance of overuse of vitamins A and D, caffeine
genetic risks family history and age
Genetic Risks – Family History and Age
  • Cystic fibrosis
  • Congenital hearing loss
  • Child-bearing after age 35

Brundage, 2002; Grody et al, 2001

folic acid
Folic Acid
  • 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

disparities in preconception care folic acid
Disparities in Preconception CareFolic 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)

disparities in preconception care folic acid19
Disparities in Preconception CareFolic 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

disparities new hiv aids cases in women number of cases per 100 000 population
Disparities - New HIV/AIDS Cases in Women(number of cases per 100,000 population)

HIV/AIDS Surveillance System, 2000

women aged 18 and older with diabetes by race ethnicity 2002
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

effects of diabetes on conception pregnancy
Effects of Diabetes on Conception & Pregnancy
  • Birth defects
    • Ventricular septal defects
    • Neural tube defects
    • Caudal regression syndrome
  • Other fetal effects
    • Macrosomia
  • Obstetric complications
    • Preeclampsia
    • Urinary tract infection
    • Premature labor
adults with diabetes who had all five recommended services
Adults With Diabetes Who Had All Five Recommended Services
  • HBA1c
  • Lipid profile
  • Retinal eye exam
  • Foot exam
  • Influenza vaccination

Hispanics

33% less likely

2004 NHQR/NHDR, 2000/2001MEPS Data

women diabetes
WomenDiabetes

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

overweight and obesity in women aged 18 and older by age 2002
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

women aged 18 and older with hypertension by race ethnicity 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

disparities in hypertension care
Disparities in Hypertension Care
  • 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

females age 15 44 reporting past month use of cigarettes by race ethnicity and pregnancy 2002
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

final remarks
Final Remarks
  • 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
final remarks31
Final Remarks
  • 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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