570 Maternal education disparities among prenatal care trends in a national sample

Abstract

Prior studies have noted inverse relationships between maternal education and adverse outcomes. Adequate prenatal care (PNC) has been shown to improve pregnancy outcomes, however the relationship with maternal education and PNC is not well understood. A population-based retrospective analysis of nulliparous, term, singleton, vertex (NTSV) deliveries using the National Center for Health Statistics’ birth certificate data. We examined the association of maternal education (some high school education, high school graduate, some college education, college graduate, post-college graduate) with PNC adequacy, defined as no PNC, 2nd/3rd trimester initiation, and at or above the median number of PNC visits. Log linear models adjusting for demographic and comorbidity factors were fit for each outcome. Interaction terms with education maternal race were assessed a priori given their close relationship and stratified models were fit. From 2016-2018, we identified 3.7 million NTSV deliveries with the plurality of patients having some college education (27.7%) followed by 23.6% graduating high school. Higher education level was associated with PNC adequacy with post college educated patients having 11% initiating PNC in the 2nd/3rd trimester, 63% less than the median PNC visits, and 0% having no PNC compared to less educated patients (Table 1). Adjusted analysis noted an inverse relationship between education and risk of no PNC, noting patients some high school education at highest risk (adjusted risk ratio (aRR) 2.88, 95% CI: 2.69-2.91). A similar trend was seen for attending less than the median number of PNC visits (aRR 1.13, 95% CI: 1.13-1.14) and 2nd/3rd trimester PNC initiation (aRR=1.60, 1.58-1.61) (Table 2). Stratified models by maternal race noted similar education findings. Lower levels of maternal education were associated with a significantly higher risk of receiving inadequate PNC, even after stratification for maternal race. Targeted efforts aimed at increasing access to high quality PNC may require screening for education and should be a public health priority.View Large Image Figure ViewerDownload Hi-res image Download (PPT)