title: Previous Adverse Infant Outcomes as Predictors of Preconception Care Use: An Analysis of the 2010 and 2012 Los Angeles Mommy and Baby (LAMB) Surveys.
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 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.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles, Los Angeles, CA, USA. priyabatra@mednet.ucla.edu.
authors.forename: Priya
authors.initials: P
authors.lastname: Batra
authors.affiliation: Los Angeles County Department of Public Health, Maternal, Child and Adolescent Health Programs, Los Angeles, CA, USA.
authors.forename: Chandra
authors.initials: C
authors.lastname: Higgins
authors.affiliation: Los Angeles County Department of Public Health, Maternal, Child and Adolescent Health Programs, Los Angeles, CA, USA.
authors.forename: Shin M
authors.initials: SM
authors.lastname: Chao
mesh_terms: D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D007230:Infant, Low Birth Weight; D015141:Los Angeles / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D016742:Preconception Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth; D011795:Surveys and Questionnaires
keywords: Adverse infant outcome; Low birth weight; Preconception care; Preterm birth