Late Initiation Of Prenatal Care Research Articles

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

BackgroundCervical cancer is the fourth most common cancer among women worldwide, both for incidence and mortality. Prevention relies on screening with a Pap test to detect precancerous lesions, which can then be treated. Access to this screening is currently both improvable and inequitable. Pregnancy may be an ideal moment for women to catch up on their overdue cervical cancer screening. In the general population, women's risk of not being screened is associated with their place of birth and other social factors; this may be true as well among pregnant women. Our objective was to study the association between women's place of birth and their failure to catch up with this screening during pregnancy.MethodsThe 2016 French National Perinatal Survey included 13,147 women who gave birth after 21 weeks of gestation. The association between their place of birth and failure to catch up on this screening (defined by the absence of a Pap test during pregnancy for women overdue for it) was adjusted for age, parity, education level, health insurance, and when they began prenatal care with logistic regression models.ResultsAmong the women for whom screening was then recommended, 49% were not up to date at the start of pregnancy, and of these, 53% were not caught up before delivery. After adjustment for other risk factors, maternal place of birth was not associated with a higher risk of failure to catch up with this screening during pregnancy. However, factors identified as associated with this risk included a low education level and late start of prenatal care.ConclusionAbout half of women overdue for cervical cancer screening did not catch up with it during their pregnancy. Professionals should pay special attention to women with lower education levels and late initiation of prenatal care, who constitute a group at high risk of not catching up on this screening during pregnancy.

Changes in prenatal care and birth outcomes after federally qualified health center expansion.

To evaluate whether the expansion of Federally Qualified Health Centers (FQHCs) improved late prenatal care initiation, low birth weight, and preterm birth among Medicaid-covered or uninsured individuals. We identified all FQHCs in California using the Health Resources and Services Administration's Uniform Data System from 2000 to 2019. We used data from the U.S. Census American Community Survey to describe area characteristics. We measured outcomes in California birth certificate data from 2007 to 2019. We compared areas that received their first FQHC between 2011 and 2016 to areas that received it later or that had never had an FQHC. Specifically, we used a synthetic control with a staggered adoption approach to calculate non-parametric estimates of the average treatment effects on the treated areas. The key outcome variables were the rate of Medicaid or uninsured births with late prenatal care initiation (>3months' gestation), with low birth weight (<2500 grams), or with preterm birth (<37 weeks' gestation). The analysis was limited to births covered by Medicaid or that were uninsured, as indicated on the birth certificate. The 55 areas in California that received their first FQHC in 2011-2016 were more populous; their residents were more likely to be covered by Medicaid, to be low-income, or to be Hispanic than residents of the 48 areas that did not have an FQHC by the end of the study period. We found no statistically significant impact of the first FQHC on rates of late prenatal care initiation (ATT: -10.4 [95% CI -38.1, 15.0]), low birth weight (ATT: 0.2 [95% CI -7.1, 5.4]), or preterm birth (ATT: -7.0 [95% CI -15.5, 2.3]). Our results from California suggest that access to primary and prenatal care may not be enough to improve these outcomes. Future work should evaluate the impact of ongoing initiatives to increase access to maternal health care at FQHCs through targeted workforce investments.

Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers

BackgroundPerinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics.MethodsWe conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15–55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care.ResultsMore immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth.ConclusionImmigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.

Combining immigration records with a postpartum population-based survey to assess prevalence of perinatal psychosocial and behavioral risk factors among immigrant subgroups.

ObjectivesPerinatal risk factors can vary by immigration status. To advance knowledge on sociobehavioral health risks among pregnant and childbearing immigrant women, we compared perinatal health indicators between immigrant and non-immigrants, overall, and according to key immigrant characteristics (refugee status, secondary migration, birth region, and duration of residence). ApproachWe conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women in Manitoba, Canada, aged 15-55 years, who had newborn screening data completed by public health nurses within two weeks postpartum from 2000 to 2017. The screening data was linked to a Canadian national immigration database. Additional databases were linked to collect demographic and perinatal clinical information. Logistic regression models were used to examine the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use and late prenatal care initiation. ResultsMore immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.90, 95% Confidence Interval (CI): 6.53, 7.28) but exhibited lower odds of other outcomes. In the analysis restricted to immigrants, recent immigrants (&lt; 5 years of stay) had higher odds of being socially isolated (aOR: 9.29, 95% CI: 7.80, 11.06) and late prenatal care (aOR: 1.73, 95% CI: 1.23, 2.42) compared to long-term immigrants, but lower odds relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with social isolation, relationship distress, depression, and late prenatal care whereas secondary migration was protective for social isolation, relationship distress, and smoking. Relationship distress and behavioral health indicators varied by maternal birth region. ConclusionThe novel linkage of birth screening data with the immigration data advances knowledge on immigrant perinatal health by identifying risk patterns for multiple psychosocial and behavioral health indicators, highlighting subgroups at higher and lower risk of exposures that may contribute to adverse perinatal health outcomes.

The perinatal epidemiology of child and adolescent marriage in Brazil, 2011–2018

Brazil is one of the top contributors of girl child marriages in the world and one of the United Nations’ members that committed to end child marriage by 2030 as part of the Sustainable Development Goals. Child marriage is an indicator of gender inequality associated with poor health outcomes. However, the perinatal epidemiology of minor mothers (<18 years) according to marital status has been insufficiently studied. We used 23,163,209 birth registrations (2011–2018) to describe the sociodemographic distribution of births to minor mothers. The association between adverse outcomes and marital status and maternal age was restricted to 7,953,739 births of mothers aged ≤15, 16–17, 18–19, 20–24 years. Multinomial logistic models were used for very (24–31 weeks) and moderately preterm birth (32–36 weeks), and severe (<3rd percentile) and moderately small-for-gestational age (SGA) (3rd to <10th percentile). Logistic models were used for binary outcomes. The proportion of births to minor mothers in the study period was 8.9%, composed of those of single (6.1%), common-law (2.4%) and married girls (0.4%). Births to minor mothers decreased over time (p-value <0.001), were more common in the North Region (13.2%) and among Indigenous (17.4%). Very and moderately preterm birth increased with decreasing age but within each age group, rates were highest among single, followed by common-law and lowest among married mothers. A similar pattern was observed for SGA, low Apgar and late prenatal care initiation. Repeat birth and low age-appropriate education were less common among married compared to single mothers in all age groups, except among ≤15-year-olds [Adjusted Odds Ratio (AOR): 2.56; 95% Confidence Interval (95%CI): 2.40, 2.74 and AOR: 1.30; 95%CI: 1.03, 1.64, respectively]. The association between perinatal indicators and marital status among adolescents is strongly modified by decreasing maternal age. Marital status is relevant for the understanding of early pregnancies.

Disparities in early prenatal care and barriers to access among American Indian and white women in North Dakota.

American Indians/Alaska Natives (AI/AN) have received minimal attention in research on determinants of prenatal care access. We sought to gain an understanding of structural and sociocultural determinants of prenatal care access among AI/AN and White women in North Dakota (ND). Data were drawn from the 2017 to 2018 North Dakota Pregnancy Risk Assessment Monitoring System (n = 1,166). Late prenatal care was assessed with 2 variables: late prenatal care initiation (>13 weeks gestation) and "Did you get prenatal care as early in your pregnancy as you wanted?" (yes/no). Those not satisfied with timing of prenatal care initiation reported 12 prenatal care barriers (yes/no). Logistic regression estimated odds ratios and 95% confidence internals for late prenatal care among AI/AN and other race/ethnicity women compared to White women. Models included maternal sociodemographic, medical, and behavior factors. Chi-square was used to examine the prevalence of prenatal care barriers by race/ethnicity. AI/AN women had increased risk of late prenatal care initiation (OR: 1.93, 95%CI: 1.20, 3.09) and were more dissatisfied with timing of prenatal care initiation (OR: 1.73, 95% CI: 1.07, 2.78) compared to White women. AI/AN women reported higher prevalence for 8 of 12 (66%) barriers to care, including lack of transportation. Lack of health insurance was more prevalent among White women than AI/AN women (45%-8.5%; P<.01). Socioeconomic barriers to prenatal care are more prevalent among AI/AN women. This may be a consequence of systematic separation of AI/AN populations from health care resources. Alternative prenatal care delivery methods and expansion of health insurance may improve prenatal care access in ND.

Posttraumatic stress and prenatal care adequacy among Black/African American women

Black/African American women with trauma histories experience a disproportionate burden of adverse perinatal outcomes. One mechanism for this association is inadequate prenatal care, as avoidant symptoms are a hallmark of posttraumatic stress disorder (PTSD). The objective of this study is to examine the association between PTSD symptoms and adequacy of prenatal care among Black/African American women. This retrospective cohort study included all pregnant women who self-identified as Black/African American and were referred to a hospital’s integrated mental health program between 2017-2021. All participants completed a PTSD Checklist -Civilian Version (PCL-C) as a part of an initial mental health evaluation. The EHR was reviewed to codify adequacy of prenatal care, which was assessed in three ways: late initiation of prenatal care (defined as gestational age at the first prenatal visit > 12 weeks), the ratio of no-show to attended prenatal visits, and the Adequacy of Prenatal Care Utilization (APNCU) Index. Bivariable analyses were performed. A propensity score for a positive PTSD screen was generated using confounders generated from a directed acyclic graph. This propensity score was included in multivariable models to control for imbalance across the exposure. Of the 111 women who met inclusion criteria, 57 (51%) screened positive on the PCL-C. Sample characteristics, stratified by a positive screen, are shown in Table 1. PCL-C score was associated with late initiation of prenatal care, the ratio of no-show to attended prenatal visits, and non-adequate prenatal care defined by the APNCU index (Table 2). The associations between late initiation of care and non-adequate APNCU index persisted in multivariable analyses. In this sample of pregnant Black/African American women with an identified mental health condition, PTSD symptoms were associated with inadequate prenatal care. The high prevalence of PTSD symptoms and the association with prenatal care emphasizes the importance of future research focused on trauma-related interventions for Black/African-American women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

381 Association between maternal birthplace and non catching-up among pregnant women overdue for cervical cancer screening

In France, the HAS recommends performing a pap test every 3 years for all sexually active women aged from 25 to 65 years old. Currently, screening access is inequitable, and pregnancy may be an ideal moment to catch-up with women who are overdue for cervical cancer screening. As in general population, several social factors associated with place of birth are also associated with less access to screening. Our objective was to study the association between maternal place of birth and non catching-up during pregnancy among the sample of women from the National Perinatal Survey (ENP 2016). The National Perinatal Survey 2016 has included 13,147 women who delivered after 22 weeks in mainland France. The factors associated with non-catching up (defined by the lack of pap test during pregnancy for overdue women) has been modelled by log-binomial regression. Multivariate analysis was adjusted on level of education, health insurance and the moment of initiation of prenatal care. Among all women included in the National Perinatal Survey and concerned by screening, 43% were overdue. Among them, 45% of women were not caught-up during pregnancy. After adjustment on covariates, women born in Northern Africa had higher risk of being not caught-up than women born in France (adjusted RR 1.14 95% CI [1.03,1.26]). A low level of education and the late initiation of prenatal care were also associated with non-catching up. 45% of overdue women are not caught-up during pregnancy. Being born in Northern Africa increases the risk of being not caught-up.

Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing.

We estimated the degree to which the association between race and spontaneous recurrent preterm delivery is mediated by the timing of the first prenatal care visit. A retrospective population-based cohort study was conducted using the U.S. National Center for Health Statistics Natality Files. We identified 644,576 women with a prior PTB who delivered singleton live neonates between 2011 and 2017. A mediation analysis was conducted using log-binomial regression to evaluate the mediating effect of timing of first prenatal care visit. During the seven-year period, 349,293 (54.2%) White non-Hispanic women, 131,296 (20.4%) Black non-Hispanic women, 132,367 (20.5%) Hispanic women, and 31,620 (4.9%) Other women had a prior preterm delivery. The risk of late prenatal care initiation was higher in Black non-Hispanic women, Hispanic women, and Other women (women of other racial/ethnic backgrounds) compared to White non-Hispanic women, and the risk of preterm delivery was higher in women with late prenatal care initiation. Between 8 and 15% of the association between race and spontaneous recurrent preterm delivery acted through the delayed timing of the first prenatal care visit. Racial disparities in spontaneous recurrent preterm delivery rates can be partly, but not primarily, attributed to timing of first prenatal care visit.

Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study.

To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.

Predictors for follow-up among postpartum patients enrolled in a clinical trial

ObjectiveTo identify risk factors for failure to attend postpartum follow-up within 3 months of delivery, including social support, intrinsic motivation, insurance type and prenatal care attendance. Study designThis planned secondary analysis is derived from a randomized controlled trial of patients intending intrauterine device (IUD) use following their delivery (n=197). Subjects were postpartum from a vaginal or cesarean birth at ≥32 weeks’ gestation. We obtained baseline demographics and certainty about their plan to receive a postpartum IUD. We administered validated scales for social support and intrinsic motivation at enrollment. We then reviewed health records for prenatal visits and any postpartum visit by 3 months and performed logistic regression to assess for predictors of follow-up. ResultsA total of 38/197 subjects (19.3%) failed to attend any postpartum visit by 3 months. Subjects who failed to follow up were more likely to have Medicaid versus private insurance (92% versus 8%, p<.01). Income <$50,000, no car, younger age, unplanned pregnancy, unemployment, multiple children, missed prenatal visits and late initiation of prenatal care were also associated with failure to follow up. Higher scores for social support and goal-directed motivation were not significantly associated with follow-up. ConclusionsIn our cohort, we found that one in five participants did not attend a postpartum visit by 3 months. Several socioeconomic indicators are associated with loss to follow-up, most notably Medicaid insurance. Having high motivation and social support is not sufficient to predict successful follow-up. ImplicationsThe main predictors for not attending a postpartum visit are Medicaid insurance or limited prenatal care, and not social support or intrinsic motivation. Interventions to improve postpartum contraception uptake should focus efforts on provision of immediate postpartum contraception for this population.

Prevalencia de inicio tardío de la atención prenatal. Asociación con el nivel socioeconómico de la gestante. Estudio de corte transversal. Bucaramanga, Colombia, 2014-2015

Objetivo: describir la prevalencia del inicio tardío de la atención prenatal y evaluar su asociación con el estrato socioeconómico donde habita la gestante.Materiales y métodos: estudio de corte transversal. Se incluyeron gestantes procedentes del área urbana de Bucaramanga, seleccionadas por muestreo por cuotas con afijación proporcional por estrato socioeconómico, según la clasificación socioeconómica del barrio donde habitan. Se consideró inicio tardío haber comenzado atención prenatal (APN) a las 12 semanas o más de gestación. Se evaluó asociación del inicio tardío con el estrato socioeconómico, controlando por variables sociodemográficas y clínicas de la gestante, y se elaboró un modelo de regresión log-binomial multivariada para estimar las razones de prevalencia con sus intervalos de confianza del 95 % (IC 95 %).Resultados: se incluyeron 391 gestantes, con edades entre 18 y 43 años, mediana 23 años; respecto a la escolaridad la mediana fue de 11 años con un rango entre 0 y 25 años. El inicio tardío se dio en el 29,7 % (IC 95 %: 25,2-34,5) de las gestantes. Estuvo asociado con estrato bajo, razón de prevalencias ([RP] = 1,57; IC 95 %: 1,08-2,56), falta de afiliación a la seguridad social al inicio del embarazo (RP = 2,73; IC 95 %: 2,04-3,67), la baja escolaridad (RP = 1,46; IC 95 %: 1,02-2,16) y la edad entre 18 y 24 años. Fueron factores protectores el recordar la fecha de la última regla (RP = 0,48; IC 95 %: 0,32-0,71) y tener pareja estable (RP = 0,82; IC 95 %: 0,64-0,98).Conclusiones: cerca de una de cada tres gestantes inicia tarde su APN. El inicio tardío está asociado con vivir en estrato socioeconómico bajo. Se requiere mejorar la captación temprana de las gestantes en esta población que presenta condiciones de inequidad en salud.

Predictors of Timely Prenatal Care Initiation and Adequate Utilization in a Sample of Late Adolescent Texas Latinas.

Little is known of late adolescent Texas Latinas' prenatal care perceptions or how these perceptions predict timely prenatal care initiation or adequate utilization. Hence, the purpose of this study is to describe and compare these perceptions between participants with timely versus late prenatal care initiation and adequate, intermediate, and inadequate prenatal care utilization; and to determine predictors of timely prenatal care initiation and adequate utilization. Fifty-four postpartum Latinas were recruited through social media. Eligibility criteria were 18 to 21 years old, Texas-born, primiparous, uncomplicated pregnancy/delivery, and English literate. Prenatal care perceptions were measured with the Revised Better Babies Survey and Access Barriers to Care Index. Participants had favorable views of prenatal care benefits; however, not living with the baby's father predicted inadequate prenatal care, Wald χ2(1) = 4.93, p = .026. Perceived benefits of timely and adequate prenatal care predicted timely prenatal care initiation, χ2(1) = 7.47, p = .006. Self-reported depression during pregnancy predicted timely entry into prenatal care, χ2(1) = 4.73, p = .03. Participants' positive prenatal care perceptions did not predict adequate prenatal care utilization, indicating that barriers serve as powerful obstacles in late adolescent Texas Latinas.

955: Beyond the window: Determining a geographical target for interventions to decrease late initiation of prenatal care in 17-P eligible pregnant women

Women with a history of spontaneous preterm birth (sPTB) are at risk for recurrence. SMFM recommends 17-P initiation between 16 0/7 to 20 6/7 weeks gestation to reduce this risk. In our clinic, 20% of eligible women present beyond the recommended window for 17-P initiation. Our objective was to determine geographic locations associated with increased rates of care initiated after 20 6/7 in women eligible for 17-P. We performed a retrospective analysis on a cohort of pregnant women with a history of prior singleton sPTB, eligible for 17-P. Women in the cohort were identified via electronic medical records at a single academic institution between January 2014 and December 2015. We compared early presenters (20 6/7 or earlier) with late presenters (21 0/7 weeks or beyond). Demographics, co-morbidities, pregnancy history and outcomes in the index pregnancy were compared using Mann-Whitney and Fisher’s exact tests. Generalized additive models (GAM) with bivariate smoothing of the participant’s residential coordinates identified spatial patterns of late presentation. GAM modeling of early vs. late presenters was compared with an area deprivation index map. There were 325 early presenters and 81 late presenters in the cohort. Late presenters were younger, majority black, more likely to be uninsured and currently abuse tobacco or other substances. Late presenters had a higher rate of preterm delivery and increased NICU admissions in the index pregnancy (table). GAM modeling identified specific urban neighborhoods with highest odds (1.7) and lowest odds (0.19) of late presentation in 17-P eligible women (figure A). The neighborhoods with highest odds correspond with areas of high area deprivation index (figure B). Women eligible for 17-P therapy who present beyond the window for 17-P initiation are clustered geographically. These target areas are optimal locations for community-based interventions focused on decreasing late initiation of care in women eligible for 17-P.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Male Fetal Sex: A Risk Factor for Gestational Diabetes Mellitus in Chinese Ethnicity [1R

INTRODUCTION: About 6-7% of pregnancies are complicated by Gestational Diabetes Mellitus (GDM); these pregnancies are at a higher risk for gestational hypertension, preeclampsia, cesarean section and other potential comorbidities. This study's objective is to determine whether Chinese mothers carrying male fetuses are at a higher risk of GDM compared with Chinese mothers carrying female fetuses. METHODS: We conducted a retrospective review of women of Chinese ethnicity who were admitted to NYU Lutheran for a delivery during calendar year 2015. This work in progress report covers all data for women with GDM and data for women without GDM from November 22, 2015 through the end of the year. Patients were excluded if they had late prenatal care initiation (&gt;28 weeks), or missing data on key variable. Data collected included: Age, BMI, delivery type, birth weight, gestational age, fetal sex, and glucose values. We used the chi-squared test to compare the proportion of mothers with GDM among those with male versus female babies. RESULTS: We analyzed data for 141 women with GDM and 110 women without GDM. Diabetic women were significantly older than non-diabetic women (mean 28.8 vs 31.0, p &lt; .001). Seventy-nine women with GDM (56%) had a male baby, while 56 (51%) non-diabetic women had a male baby, the difference was not statistically significant. CONCLUSION: This study did not show a difference between diabetic and non-diabetic women in terms of fetal sex, however, it was not adequately powered and a larger study may show a different result.

Bridging the Gaps in Obstetric Care: Perspectives of Service Delivery Providers on Challenges and Core Components of Care in Rural Georgia.

Objectives In 2011, a workforce assessment conducted by the Georgia Maternal and Infant Health Research Group found that 52% of Primary Care Service Areas outside metropolitan Atlanta, Georgia, had an overburdened or complete lack of obstetric care services. In response to that finding, this study's aim was twofold: to describe challenges faced by providers who currently deliver or formerly delivered obstetric care in these areas, and to identify essential core components that can be integrated into alternative models of care in order to alleviate the burden placed on the remaining obstetric providers. Methods We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and maternal and infant health leaders in Georgia. Interviews were digitally recorded, transcribed verbatim, uploaded into MAXQDA software, and analyzed using a Grounded Theory Approach. Results Providers faced significant financial barriers in service delivery, including low Medicaid reimbursement, high proportions of self-pay patients, and high cost of medical malpractice insurance. Further challenges in provision of obstetric care in this region were related to patient's late initiation of prenatal care and lacking collaboration between obstetric providers. Essential components of effective models of care included continuity, efficient use of resources, and risk-appropriate services. Conclusion Our analysis revealed core components of improved models of care that are more cost effective and would expand coverage. These components include closer collaboration among stakeholder populations, decentralization of services with effective use of each type of clinical provider, improved continuity of care, and system-wide changes to increase Medicaid benefits.

732: Impact of late initiation of prenatal care on pregnancy outcomes among women who use drugs

732: Impact of late initiation of prenatal care on pregnancy outcomes among women who use drugs

Health Behavior's Deference in Intended and Unintended Pregnancies

Most of unintended pregnancies occur in developing countries that cause mortality and morbidity in the number of mothers every day. In unintended pregnancies, women Show different health behaviors such as late initiation of prenatal care or supplement taking. This case-control survey conducted on 240 parturient presenting for vaginal delivery. Samples were selected using a continued method and accordingly unintended or intended pregnancies were placed in two groups: case (n=80) and control (n=160). Health behaviors were recorded using given questions, and prenatal care clinics. Statistical analysis was performed using man-Whitney, Students t-test, and chi-squared test where appropriate. Finding of present study showed a meaningful statistical difference evidences for maternal health behaviors. There was statistical difference between two groups in preconception counseling, entry into prenatal care, and supplement taking. According to the findings of the present study, unintended pregnancies are more likely to result in adverse health behaviors. It is recommended that health services be delivered effectively to women to make them aware of unintended pregnancy morbidity and to encourage family programming in their life.

Gestational Weight Gain Among Hispanic Women

To describe gestational weight gain among Hispanic women and to examine psychological, social, and cultural contexts affecting weight gain. A total of 282 Hispanic women were surveyed post-partum before leaving the hospital. Women were queried about their prepregnancy weight and weight gained during pregnancy. Adequacy of gestational weight gain was based on guidelines set by the Institute of Medicine in 2009. Independent risk factors for excessive or insufficient weight gain were examined by logistic regression. Most women were unmarried (59%), with a mean age of 28.4±6.6years and an average weight gain of 27.9±13.3lbs. Approximately 45% of women had gained too much, 32% too little, and only 24% had an adequate amount of weight gain. The mean birth weight was 7.3, 7.9, and 6.8lbs among the adequate, excessive, and insufficient weight gain groups. Among women who exercised before pregnancy, two-thirds continued to do so during pregnancy; the mean gestational weight gain of those who continued was lower than those who stopped (26.8 vs. 31.4lbs, p=0.04). Independent risk factors for excessive weight gain were being unmarried, U.S. born, higher prepregnancy body mass index, and having indifferent or negative views about weight gain. Independent risk factors for insufficient weight gain were low levels of support and late initiation of prenatal care. Depression, stress, and a woman's or her partner's happiness regarding pregnancy were unrelated to weight gain. The results of this study can be used by prenatal programs to identify Hispanic women at risk for excessive or insufficient gestational weight gain.

Adequate Prenatal Care Reduces the Risk of Adverse Pregnancy Outcomes in Women with History of Infertility: A Nationwide Population-Based Study

ObjectivesTo investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility.Study DesignA retrospective cohort study.MethodsData were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis.ResultsWomen diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care.ConclusionsStudy findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility.