Association Between Recommended Preconception Health Behaviors and Screenings and Improvements in Cardiometabolic Outcomes of Pregnancy

Kaitlyn K. Stanhope, PhD, MPH; Michael R. Kramer, PhD, MMSc

Disclosures

Prev Chronic Dis. 2021;18(1):e06 

In This Article

Results

Overall, 8.4 of women reported an HDP and 6.2% reported GDM (Table 1). The prevalence of both conditions varied most by race/ethnicity, age, and educational level, and both conditions were more common among older women. HDP were most common among non-Hispanic Black women (12.6%), whereas GDM was most common among American Indian/Alaska Native women (13.1%). No clear pattern was found for HDP by maternal education. However, women with the least education (<8th grade) were the most likely to report a diagnosis of GDM (8.5% compared with 6.4% among women with a college degree or higher).

Preconception indicators across all domains varied by maternal race/ethnicity (Table 2). Most women did not receive advice about improving their health before pregnancy (70.7%). Asian and non-Hispanic White women were the most likely to have insurance 1 month before conception and non-Hispanic White women were more likely to attend a check-up or have a teeth cleaning 1 year before conception. Hispanic women were the least likely to have insurance (35.4% uninsured). Non-Hispanic Black women (38.7%) were the most likely to report the pregnancy as unintended, followed by American Indian/Alaska Native women (27.2%). Non-Hispanic White women were more likely to report drinking prior to conception and engaging in protective behaviors (vitamin use or exercise) compared with any other racial/ethnic group. American Indian/Alaska Native women were the most likely to report a diagnosis of depression in the year before pregnancy (18.7% compared with 12.6% overall). Non-Hispanic Black women were more likely to report a prepregnancy diagnosis of hypertension compared with all other groups (8.6% compared with 5.2% overall).

Adjusting for all covariates (age, race/ethnicity, insurance, BMI, prepregnancy check-up), the strongest preconception predictor of GDM was prepregnancy obesity (aOR, 3.1; 95% CI, 2.7–3.5) followed by receiving prepregnancy advice to improve health compared with not receiving advice (aOR, 1.4; 95% CI, 1.2–1.5), and lack of insurance (aOR, 1.2; 95% CI, 1.0–1.4) (Table 3). In adjusted models, other individual behaviors (exercising before pregnancy, drinking before pregnancy, a prepregnancy check-up, or taking folic acid) were not associated with decreased risk of GDM.

Similarly, prepregnancy obesity was the strongest preconception predictor of HDP across all models (aOR, 3.1; 95% CI, 2.8–3.5, adjusted model) (Table 3). Maternal report of a prepregnancy diagnosis of diabetes (aOR 2.3; 95% CI, 1.7–3.0) was also associated with elevated risk of HDP. Reported prepregnancy advice about improving health was associated with increased risk of HDP (aOR, 1.1; 95% CI, 1.0–1.3). The only maternal behavior associated with decreased risk of HDP was teeth cleaning in the year before pregnancy (aOR, 0.8; 95% CI, 0.7–0.9).

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