Systemic and Individual Determinants of Maternal Morbidity in the United States

Abstract

s / Annals of Epidemiology 25 (2015) 702e719 712 P40. Systemic and Individual Determinants of Maternal Morbidity in the United States Riddhi Doshi MBBS, MPH, Gregory Vaughan, Jun Yan PhD, Kiesha Benn MD, Robert H. Aseltine Jr. PhD. University of Connecticut Purpose: Obstetric trauma to the perineum and vulva was among the top five causes of hospitalization among young adults, resulting in almost 7.5 million hospital stays among Medicaid beneficiaries alone. Childbirth and related complications cost over 16 billion US dollars annually. The primary objective of this study is to determine the prevalence of perineal lacerations during childbirth, examine the associations with individual and systemic predictors and predict the risk of obstetric trauma. Methods: For this large retrospective cohort study, we utilized data regarding hospital deliveries from 30 hospitals integrated through the Connecticut Acute Care Hospital Inpatient Discharge Database (HIDD). Predictors can be broadly classified into individual (demographic, socioeconomic, clinical) and systemic (facility volume, payer/insurance type). Outcomes examined were 3rd and 4th degree perineal lacerations. R statistical package was utilized to perform generalized linear models. Logistic regressionmodeling was utilized to predict the risk of perineal injuries with significant systemic determinants. Results: Insurance type (p<0.001) and facility volume (p<0.001) of the delivering hospital were found to be significant systemic determinants of perineal injuries after childbirth. Income (p<0.025), maternal age (p<0.001) and instrument use (p<0.001) were significant predictors of trauma. Asian race doubled the odds of trauma (OR: 2.15; 95%CI 1.89-2.44) while instrument use increased it four times (OR: 3.98; 95%CI 3.56-4.44). Conclusions: The association between systemic factors like larger facility volume in terms of number of deliveries is a critical finding. This warrants further temporospatial investigation into facility-based systemic determinants of maternal health. P41. Systematic Determinants of Anemia Among Women in India: A Dis-integrated Analyses of Pregnant, Lactating and Non-Pregnant and Non-Lactating Women Riddhi Doshi MBBS, MPH, Srinivas Goli PhD. University of Connecticut Purpose: The prevalence of anemia among pregnant women in developing countries is almost five times that among developed countries [Prevalence: development (14%); developing (51%)]. India bears a high burden (upto 70%) of anemia prevalence. This study aims to determine the predictors of anemia among pregnant and lactatingwomen, thereby providing guidance for tailored health policy and programs. Methods: Analyses were performed on data from the National Family Health Survey (2005-06). Three binary logistic regression models determined the association of sociodemographic and economic predictors with the occurrence of anemia among pregnant, lactating, non-pregnant and non-lactating women. In addition, the regression models for pregnant and lactating women included predictors related to healthcare-seeking during pregnancy. Results: For pregnant women, duration of pregnancy, 2 children, work status, education of partners, wealth quintile, nutritional advice and supplementary nutritionwere found to be significant predictors. Among lactating women, the odds of anemia significantly increased during the third trimester. Young age (15-24 years), primary education among women and secondary education among partners significantly reduced the odds of developing anemia. For nonpregnant, non-lactating women, age 25 years, caste, secondary and higher education among women, primary education among partners, highest wealth quintile had a protective effect. Conclusions: Economic, cultural and individual factors need to be considered while assessing risk of anemia among pregnant and lactating women. India needs to strengthen Maternal and Child Health programs through a focus on nutritional care during pregnancy in order to improve the overall health outcomes among women.