262158 Barriers to prenatal care for women with pre-existing diabetes in Mississippi

Tuesday, October 30, 2012 : 3:30 PM - 3:50 PM

Meagan Robinson, MPH , Office of Health Data and Research, Mississippi State Department of Health, Jackson, MS
Mary Wesley, MPH , Office of Health Data & Research, Mississippi State Department of Health, Jackson, MS
Connie Bish, PhD, MPH , Maternal Child Health and Health Services, Mississippi State Department of Health, Jackson, MS
Amel Mohamed, MPH , Chronic Disease Programs, Mississippi State Department of Health, Jackson, MS
     
BACKGROUND: Inadequate prenatal care (PNC) is associated with morbidity and mortality in pregnancies complicated by chronic conditions like diabetes.

STUDY QUESTION: What PNC barriers are reported by pregnant women with pre-existing diabetes in Mississippi?

METHODS: Mississippi PRAMS data (2004-2009) were analyzed for this cross-sectional study (n=5,248). PNC initiation by trimester, mean number of PNC barriers, and specific barriers were calculated for diabetic vs. non-diabetic women. Analyses were conducted in SAS/SUDAAN and weighted to produce unbiased estimates.

RESULTS: Three percent of women who gave birth in the study years reported pre-existing diabetes. The percentage of women with vs. without pre-existing diabetes who initiated PNC were: 1st trimester (62.8% vs. 75.5%), 2nd trimester (33.6% vs. 22.2%), 3rd trimester (0.4% vs. 1.03%), and no prenatal care (3.2% vs. 1.3%) (p=0.03). Approximately 18.0% of women with pre-existing diabetes did not receive PNC as early as desired. Common barriers among women with pre-existing diabetes included: not enough money (21.7%), no Medicaid card (34.8%), no early insurance care (20.5%), no transportation (18.1%), and wanted pregnancy kept secret (15.7%). The average number of barriers, 1.8 vs. 1.9, did not differ between women with vs. without pre-existing diabetes, respectively.

CONCLUSIONS: Diabetic women initiated PNC later than non-diabetic women. A number of barriers to PNC exist among pregnant women with pre-existing diabetes.

PUBLIC HEALTH IMPLICATIONS: Diabetes care providers, women's health programs, chronic disease programs, and health policy leaders could collaborate to eliminate barriers and support early PNC among women with chronic conditions like diabetes.

Learning Areas:
Chronic disease management and prevention
Epidemiology

Learning Objectives:
1. Identify a number of PNC barriers among pregnant women with pre-existing diabetes. 2. Discuss collaborations to improve access to health services.

Keywords: Diabetes, Prenatal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am lead author on the abstract submitted and spent time working and learning under those specializing in chronic disease epidemiology while completing credentials in public health science. My scientific interests are in chronic disease epidemiology and health promotion.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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