Trends in Early Prenatal Care Among Women with Pre-Existing Diabetes: Have Income Disparities Changed?
AffiliationUniv Arizona, Sarver Heart Ctr, Div Cardiol
MetadataShow full item record
PublisherMARY ANN LIEBERT, INC
CitationKhadijah Breathett, Jessica Filley, Madhaba Pandey, Nayanjot Rai, and Pamela N. Peterson. Journal of Women's Health. Jan 2018. ahead of print http://doi.org/10.1089/jwh.2016.6031
JournalJOURNAL OF WOMENS HEALTH
RightsCopyright © 2018, Mary Ann Liebert, Inc.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractBackground: Women with pre-existing diabetes are at high maternal risk for comorbidities and death, particularly when early prenatal care is not received. Low income is a known barrier to early prenatal care. It is unknown whether recent policies to expand access to prenatal care have reduced income disparities. We hypothesized that income disparities would be minimized and that the odds of receipt of first trimester prenatal care among women with pre-existing diabetes would become similar across income strata over time. Material and Methods: Using the Colorado birth certificate registry from 2007 to 2014, receipt of prenatal care was assessed retrospectively in 2,497 women with pre-existing diabetes. Logistic regression was used to examine the association between high (>$50,000), medium ($25,000-50,000), and low (<$25,000) income strata and receipt of first trimester prenatal care by birth year, adjusted for demographics. Results: High, medium, and low income represented 29.5%, 19.0%, and 51.5% of the cohort, respectively. Women with high income were more likely to receive first trimester care than women with low income from 2007 [adjusted odds ratio, 95% confidence interval: 2.16 (1.18, 3.96)] through 2013 [1.66 (1.01, 2.73)], but significant differences were no longer observed in 2014 [1.59 (0.89, 2.84)]. The likelihood of receiving first trimester prenatal care was not significantly different between medium- and low-income strata from 2007 [1.07 (0.66, 1.74)] through 2014 [0.77 (0.48, 1.23)]. Conclusions: From 2007 to 2013, women in Colorado with diabetes were more likely to receive early prenatal care if they were in the highest income stratum than in the lowest stratum. In 2014, receipt of first trimester care became equitable across all income strata. Future work should examine national patterns of income with receipt of prenatal care and outcomes among women with pre-existing diabetes.
Note12 month embargo; published online: 1 January 2018
VersionFinal accepted manuscript
SponsorsT32 training grant from the National Institute of Health [5T32 HL116276-02]; Loan Repayment Award from the National Institute of Health [L60 MD010857]; American Heart Association Strategically Focused Research Network for Heart Failure [16SFRN29640000]; University of Colorado, Department of Medicine, Health Services Research Development Grant Award
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