Abstract 296: Factors Associated with Inadequate Prenatal Care in Women with Pre-Gestational Hypertension

Abstract

BACKGROUND: Pre-gestational hypertension (HTN) remains a compelling problem, both cardiological and obstetrical. It can increase risk of unfavorable maternal and neonatal outcomes, especially in patients without adequate prenatal care. Little is known about factors associated with inadequate prenatal care in women with pre-gestational HTN, beyond racial and ethnic disparities. HYPOTHESIS: We hypothesized that social factors are associated with inadequate prenatal care in pre-gestational HTN women, beyond race/ethnicity-related disparities. METHODS: A case-control study of adequacy of prenatal care was conducted in 1,635 women with pre-gestational HTN who were living and gave birth in the State of Ohio in 2010. The comprehensive births data for the year 2010 were obtained from the Ohio Department of Health. Cases were identified as those with inadequate prenatal care; controls were identified as those with adequate-plus, adequate, or intermediate care, as defined by the Adequacy of Prenatal Care Utilization Index (the Kotelchuk Index). Adjusted odds ratios for inadequate care in pre-gestational HTN women in relation to their demographic and socio-economic characteristics were obtained using multivariable logistic regression (SAS software). RESULTS: A total of 14.4% (235 of 1,635) pre-gestational HTN women received inadequate prenatal care. In pre-gestational HTN women, adequacy of prenatal care was statistically significantly associated with their level of educational attainment and marital status, even after adjustment for race and ethnicity. Compared to pre-gestational HTN women with a higher educational level (at least some college or higher), pre-gestational HTN women with a lower educational level (high school or below) were 1.69 times more likely to receive inadequate prenatal care as measured by the Kotelchuk Index (began prenatal care late and/or completed less than 50% of the recommended visits) (OR 1.69, 95% CI 1.20-2.38, p<0.01). Unmarried pre-gestational HTN women were statistically significantly more likely to receive inadequate care than their married counterparts (OR 1.57, 95% CI 1.09-2.27, p=0.02). Compared to white pre-gestational HTN women, black (OR 2.52, 95% CI 1.76-3.62, p<0.001), Asian (OR 3.82, 95% CI 1.50-9.71, p=0.01), and Native American (OR 4.84, 95% CI 1.03-22.87, p=0.04) pre-gestational HTN women were at higher risk of receiving inadequate care. No statistically significant difference between Hispanic and non-Hispanic pre-gestational HTN women was observed. CONCLUSIONS: Although white women with pre-gestational HTN are at lowest risk of receiving inadequate prenatal care, these disparities cannot be attributed to race and ethnicity only. Pre-gestational HTN women with lower educational attainment and unmarried women are at higher risk of receiving inadequate prenatal care. Pre-gestational risk stratification and management of HTN in women during pregnancy by the cardiologist are warranted.