Defining preconception wellness and examining its association with preterm birth and its clinical subtypes among Georgia mothers
Kanu, Florence Adanma
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Background: There is a growing consensus that preconception care, rather than prenatal care, throughout the life course is the ideal practice. Expecting the short period of prenatal care to reverse the impact of early life programming and cumulative allostatic load on a woman’s reproductive health may be impractical. The purpose of this dissertation was to 1) examine the distribution of preconception wellness indicators, 2) to examine the association between preconception wellness and preterm birth overall, and 3) to examine the association between preconception wellness and preterm birth clinical subtypes. Methods: Data were collected during 2009-2013 in the Georgia Pregnancy Risk Assessment Monitoring System (PRAMS), a state specific population-based surveillance system that collects data on select maternal behaviors and experiences occurring before, during, and shortly after pregnancy. Nine preconception wellness indicators as defined by the Clinical Workgroup of the CDC Preconception Health and Healthcare Initiative were examined, including pregnancy intention, access to care, folic acid use, tobacco avoidance, depression screening/treatment, diabetes screening/treatment, healthy weight, absence of sexually transmitted infections, and teratogen avoidance. Preconception wellness indicators experienced per mom were summed and categorized as 1-3, 4-6, and 7-9 for analysis. Descriptive statistics, bivariate analyses, and logistic regression models assessed the experience of preconception wellness individually and cumulatively by PTB overall and by its clinical subtypes. Results: About 9% of mothers delivered an infant who was less than 37 weeks’ gestation. Preconception wellness indicators experienced ranged from 7.7% (depression screening/treatment) to 96.9% (absence of sexually transmitted infection). As the number of cumulative PCW indicators increased, the odds of PTB decreased; however, this decreases in odds were not statistically significant. As the number of cumulative PCW indicators increased, the odds of SPTB decreased and the odds of MIPTB increased; however, these trends were not significantly different from moms who experienced 1 to 3 PCW indicators. Conclusion: By applying the Clinical Workgroup's concept of preconception wellness to Georgia PRAMS, we provided a baseline for preconception wellness among Georgia moms. Given PRAMS’ standardized methodology, this study can be replicated within other PRAMS sites to aid in the prioritization of preconception wellness in the United States.