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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 2000 7.6% of babies were born at ≤ 2,500 grams – LBW

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Disparities in Preconception Health Care: An Overview

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  1. 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

  2. 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

  3. 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

  4. Preconception & Prenatal Care Risk reduction obstetric complications Improved pregnancy outcomes

  5. Percent of Births By Age Groups

  6. Racial/ethnic minority women of child-bearing age have particularly poor access to care MEPS 2001

  7. Poorer communication with health care providers MEPS 2001

  8. Women’s Perception of Cultural Competency % 2003 NHQR/NHDR

  9. Essential Components of Preconception Care in the Primary Care Setting • Risk assessment • Health promotion • Intervention

  10. 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)

  11. Preconception Health Care Checklist • Screening for infectious diseases, treatment, immunization, counseling: • HIV/AIDS • Hepatitis B • Rubella • Varicella • Toxoplasmosis • Cytomegalovirus • Parvovirus-19

  12. Preconception Health Care Checklist • Environmental toxins: • Occupational exposures • Household chemicals • Smoking cessation • Alcohol screening • Illegal drug use screening

  13. Preconception Health Care Checklist • Medical assessment: • Diabetes • Hypertension • Epilepsy • DVT • Depression/anxiety

  14. 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

  15. Race/Ethnicity & Genetic Risks (Cowchick et al, 1994)

  16. Genetic Risks – Family History and Age • Cystic fibrosis • Congenital hearing loss • Child-bearing after age 35 Brundage, 2002; Grody et al, 2001

  17. 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

  18. 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)

  19. 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

  20. Disparities - New HIV/AIDS Cases in Women(number of cases per 100,000 population) HIV/AIDS Surveillance System, 2000

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. † 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

  27. 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

  28. 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

  29. 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

  30. 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.

  31. Thank You! rcorrea@ahrq.gov

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