Previous Adverse Infant Outcomes as Predictors of Preconception Care Use: An Analysis of the 2010 and 2012 Los Angeles M
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Previous Adverse Infant Outcomes as Predictors of Preconception Care Use: An Analysis of the 2010 and 2012 Los Angeles Mommy and Baby (LAMB) Surveys Priya Batra1 • Chandra Higgins2 • Shin M. Chao2
Published online: 17 December 2015 Ó Springer Science+Business Media New York 2015
Abstract Objectives This study aimed to understand the impact of a previous adverse infant outcome (AIO) on use of preconception care prior to a subsequent pregnancy. Methods Responses from the 2010 and 2012 Los Angeles Mommy and Baby Surveys were analyzed. Weighted multivariate logistic regression was employed to identify significant associations between having had a previous AIO (preterm delivery, low birth weight infant, stillbirth, or major birth defect) and receipt of preconception care prior to the most recent pregnancy. Select patient-level covariates were included: chronic disease, age, education level, race/ethnicity, country of birth, insurance status prior to pregnancy and pregnancy intent. Adjustment for missing responses was performed using multiple chained imputation. Results After controlling for covariates, having had a previous AIO was associated with an increased odds of having utilized preconception care in the most recent pregnancy (OR 1.237, p = 0.040). Per the final regression model, a woman reporting a previous AIO and an intended
& Priya Batra [email protected] Chandra Higgins [email protected] Shin M. Chao [email protected] 1
Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles, Los Angeles, CA, USA
2
Los Angeles County Department of Public Health, Maternal, Child and Adolescent Health Programs, Los Angeles, CA, USA
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subsequent pregnancy had a 42.4 % likelihood of having used preconception care. Of these women, only 28.8 % reported doing so because of concern regarding a previous birth complication. Discussion Women reporting a previous AIO were more likely to have used preconception care in a subsequent pregnancy. The prevalence of preconception care utilization remained low overall. Pregnancy intent emerged as a strong secondary predictor; any concerted strategy to improve access to preconception care must include initiatives to help ensure that pregnancies are planned. Keywords Adverse infant outcome Preterm birth Low birth weight Preconception care
Significance What is known on this subject: Preconception care—the optimization of a woman’s health prior to pregnancy—has been shown to increase healthy behaviors in pregnancy and impact the incidence of some adverse birth outcomes. Despite this, preconception care is not widely accessed in the U.S. It is known that some patient characteristics (i.e., education, age, insurance status, chronic medical conditions) can influence preconception care utilization. What this study adds: Little is known about the effect of having had a previous adverse infant outcome on preconception care use. Preconception care may be particularly relevant for these patients, as some risk factors for adverse infan
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