205355 Association of diabetes, eclampsia, BMI, hypertension and behavioral risks with poor pregnancy outcomes among high risk African Americans (AAs) in Washington, DC

Wednesday, November 11, 2009: 9:05 AM

M. Nabil El-Khorazaty, PhD , Statistics and Epidemiology Unit, RTI International, Rockville, MD
Ayman El-Mohandes, MD, MBBCh, MPH , College of Public Health, University of Nebraska Medical Center, Omaha, NE
Jutta S. Thornberry, BA , Statistics and Epidemiology Unit, RTI International, Rockville, MD
Michele Kiely, DrPH , Division of Epidemiology, Statistics & Prevention Research, National Institute of Child Health and Human Development/NIH, Rockville, MD
The relationship between diabetes, eclampsia, Body Mass Index (BMI), hypertension and behavioral risks (smoking, environmental tobacco smoke, depression, intimate partner violence (IPV)), and adverse pregnancy outcomes (low birthweight (LBW), preterm births (PTB) and large-for-gestational-age (LGA)) in high risk AAs in Washington, DC was investigated. 1044 pregnant AAs were enrolled and interviewed at baseline, 2nd, and 3rd trimester. Birthweight and gestational age were abstracted from medical records. Classification and Regression Trees (CART) was used. Women were more likely to have LBW (<2,500 grams) babies if diagnosed with: eclampsia (OR=3.13,p=0.002), preconception diabetes & no gestational hypertension (OR=3.14,p=0.018), and smoking, preconception diabetes & no gestational hypertension (OR=1.76,p=0.037). Women were more likely to have PTB (<37 weeks gestation) if diagnosed with: eclampsia and no preconception diabetes (OR=2.47,p=0.031), preconception diabetes (OR=3.93,p=0.002), chronic hypertension, no preconception diabetes & no IPV (OR=2.63,p=0.74), or IPV & no preconception diabetes (OR=1.55,p=0.058). LGA (>90th percentile) was more likely for those diagnosed with: preconception diabetes (OR=5.22,p<0.001), gestational diabetes & not smoking (OR=2.70,p=0.180). Eclampsia and BMI were most important predictors of LBW, followed by gestational hypertension, education & preconception diabetes. For very LBW (<1,500 grams) babies, BMI & gestational diabetes were most important predictors. For PTB and very PTB (<34 weeks gestation) and LGA, BMI was the most important predictor. BMI and eclampsia, followed by preconception diabetes and IPV were the most important predictors of PTB and very PTB. Screening not only for medical but also for behavioral risks should receive high priority. This will increase maternal survival and improve pregnancy outcomes.

Learning Objectives:
1. To understand the assiociation between medical and behavioral conditions and pregnancy outcomes. 2. To differentiate the role of medical and pscho-behavioral risks. 3. To emphasize the importance of screening pregnant women for both medical and behavioral risks.

Keywords: African American, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an author on the content of this abstract as a Principal Investigator of the Data Coordinating Center for this study under which the data were collected and analyzed.
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.

See more of: Diabetes Epidemiology
See more of: Epidemiology