Disparities in prenatal care utilization among u.s. versus foreign-born women with chronic conditions

Background: Adequate PNCU is especially important among women with chronic conditions due to their increased risk for poor outcomes. Research on the relationship between nativity and prevalence of chronic conditions is limited and findings are inconsistent. The aim of this study was to determine if foreign-born women with chronic conditions had similar patterns of PNCU to U.S.-born women with chronic conditions.

Methods: We used the 2001 to 2002 NCHS natality files for complete information for the PNCU index and nativity. The dependent variable was PNCU based on the R-GINDEX. Maternal nativity and the presence of a chronic condition (diabetes or hypertensive disorder) were independent variables. We calculated odds ratios for each PNCU group and by chronic condition, using U.S.-born mothers as the reference group.

Results: The proportion of diabetes is higher overall in foreign-born population compared to U.S.-born; for hypertensive disorder, the proportion is higher in U.S.-born. There was evidence of racial differences among foreign-born. Foreign-born women with diabetes had a significantly higher odds of reporting inadequate PNCU (aOR=1.62, 95% CI=1.54-1.71) compared to U.S.-born with the same condition. A similar pattern was observed for women with hypertensive disorders (aOR=1.51, 95% CI=1.44-1.58)

Conclusions: Despite higher proportion of some chronic conditions, foreign-born women with chronic conditions have higher levels of inadequate PNCU compared to U.S.-born women with the same conditions. This study suggests the need for increased PNCU among foreign-born women, especially those with chronic conditions. Further examination of racial and ethnic differences by nativity status is needed.