Abstract
Introduction
Women with pre-pregnancy diabetes or pre-pregnancy hypertension have increased risks of complications during pregnancy. Women who obtain prenatal care in the first trimester receive necessary routine testing and disease management tools that aid in controlling such conditions. However, research on the association between pre-pregnancy hypertension and pre-pregnancy diabetes and prenatal care timing among US women is limited.
Methods
This study used data from the 2018 National Vital Statistic System (n = 3,618,853). Trained personnel collected information on prenatal care timing, maternal conditions, and demographics. Multivariate logistic regression models evaluated the association between pre-pregnancy hypertension, pre-pregnancy diabetes and prenatal care timing. A stratified analysis was conducted to determine if race/ethnicity modified the associations.
Results
After adjustment, women with pre-pregnancy hypertension or pre-pregnancy diabetes had statistically significant increased odds of receiving early prenatal care compared to women without these conditions (OR 1.23; 95% CI: 1.21-1.26 and OR 1.27; 95% CI: 1.24-1.31, respectively). Among non-Hispanic White, non-Hispanic Black, and Hispanic women, those with pre-pregnancy hypertension or pre-pregnancy diabetes had statistically significantly increased odds of receiving early prenatal care compared to women without those pre-existing conditions (P < .001).
Discussion
Further research is needed on the transition from preconception care to obstetric care for women with pre-existing diabetes or hypertension. However, these findings suggest that women who have conditions that could cause pregnancy complications are pursuing early prenatal care services to mitigate the development of adverse maternal and infant health conditions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
This study used national birth certificate data, secondary analysis, a de-identified, publicly available dataset that can be accessed at the National Center for Health Statistics. Local institutional review board (IRB) review was not required.
Code availability
Not applicable.
References
Azeez, O., Kulkarni, A., Kuklina, E. V., Kim, S. Y., & Cox, S. (2019). Hypertension and diabetes in non-pregnant women of reproductive age in the United States. Preventing Chronic Disease, 16, E146. https://doi.org/10.5888/pcd16.190105
Blakeney, E. L., Herting, J. R., Bekemeier, B., & Zierler, B. K. (2019). Social determinants of health and disparities in prenatal care utilization during the great recession period 2005–2010. BMC Pregnancy and Childbirth, 19(1), 390. https://doi.org/10.1186/s12884-019-2486-1
Breathett, K., Filley, J., Pandey, M., Rai, N., & Peterson, P. N. (2018). Trends in early prenatal care among women with pre-existing diabetes: Have income disparities changed? Journal of Women’s Health (2002), 27(1), 93–98. https://doi.org/10.1089/jwh.2016.6031
Budtz-Jørgensen, E., Keiding, N., Grandjean, P., & Weihe, P. (2007). Confounder selection in environmental epidemiology: Assessment of health effects of prenatal mercury exposure. Annals of Epidemiology, 17(1), 27–35. https://doi.org/10.1016/j.annepidem.2006.05.007
Butwick, A. J., Druzin, M. L., Shaw, G. M., & Guo, N. (2020). Evaluation of US state-level variation in hypertensive disorders of pregnancy. JAMA Network Open, 3(10), e2018741. https://doi.org/10.1001/jamanetworkopen.2020.18741
Cameron, N. A., Molsberry, R., Pierce, J. B., Perak, A. M., Grobman, W. A., Allen, N. B., Greenland, P., Lloyd-Jones, D. M., & Khan, S. S. (2020). Pre-pregnancy hypertension among women in rural and urban areas of the United States. Journal of the American College of Cardiology, 76(22), 2611–2619. https://doi.org/10.1016/j.jacc.2020.09.601
CDC. Hypertension Prevalence in the U.S. | Million Hearts®. Centers for Disease Control and Prevention. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html. Accessed 22 Mar 2021
Chinn, J. J., Eisenberg, E., Artis Dickerson, S., King, R. B., Chakhtoura, N., Lim, I. A. L., Grantz, K. L., Lamar, C., & Bianchi, D. W. (2020). Maternal mortality in the United States: Research gaps, opportunities, and priorities. American Journal of Obstetrics and Gynecology, 223(4), 486-492.e6. https://doi.org/10.1016/j.ajog.2020.07.021
Chinn, J. J., Martin, I. K., & Redmond, N. (2021). Health equity among black women in the United States. Journal of Women’s Health (2002), 30(2), 212–219. https://doi.org/10.1089/jwh.2020.8868
Coley, S. L., Zapata, J. Y., Schwei, R. J., Mihalovic, G. E., Matabele, M. N., Jacobs, E. A., & Anderson, C. K. (2018). More than a “Number”: perspectives of prenatal care quality from mothers of color and providers. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 28(2), 158–164. https://doi.org/10.1016/j.whi.2017.10.014
Deputy, N. P., Kim, S. Y., Conrey, E. J., & Bullard, K. M. (2018). Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth—United States, 2012-2016. MMWR Morbidity and Mortality Weekly Report, 67(43), 1201–1207. https://doi.org/10.15585/mmwr.mm6743a2
Gad, M. M., Elgendy, I. Y., Mahmoud, A. N., Saad, A. M., Isogai, T., Sande Mathias, I., Misbah Rameez, R., Chahine, J., Jneid, H., & Kapadia, S. R. (2021). Disparities in cardiovascular disease outcomes among pregnant and post-partum women. Journal of the American Heart Association, 10(1), e017832. https://doi.org/10.1161/JAHA.120.017832
Gadson, A., Akpovi, E., & Mehta, P. K. (2017). Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Seminars in Perinatology, 41(5), 308–317. https://doi.org/10.1053/j.semperi.2017.04.008
Groskaufmanis, L., Brunner Huber, L. R., & Vick, T. (2018). Group prenatal visits: Maternal and neonatal health outcomes. Journal of Midwifery & Women’s Health. https://doi.org/10.1111/jmwh.12764
Kachoria, R., & Oza-Frank, R. (2014). Receipt of preconception care among women with prepregnancy and gestational diabetes. Diabetic Medicine: A Journal of the British Diabetic Association, 31(12), 1690–1695. https://doi.org/10.1111/dme.12546
Kitsantas, P., Gaffney, K. F., & Cheema, J. (2012). Life stressors and barriers to timely prenatal care for women with high-risk pregnancies residing in rural and nonrural areas. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 22(5), e455-460. https://doi.org/10.1016/j.whi.2012.06.003
Kitzmiller, J. L., Ferrara, A., Peng, T., Cissell, M. A., & Kim, C. (2018). Preexisting Diabetes and Pregnancy. In C. C. Cowie, S. S. Casagrande, A. Menke, M. A. Cissell, M. S. Eberhardt, J. B. Meigs, E. W. Gregg, W. C. Knowler, E. Barrett-Connor, D. J. Becker, F. L. Brancati, E. J. Boyko, W. H. Herman, B. V. Howard, K. M. V. Narayan, M. Rewers, & J. E. Fradkin (Eds.), Diabetes in America (3rd ed.). National Institute of Diabetes and Digestive and Kidney Diseases (US). http://www.ncbi.nlm.nih.gov/books/NBK567999/. Accessed 8 Sept 2021.
Kuklina, E. V. (2020). Hypertension in pregnancy in the US—one step closer to better ascertainment and management. JAMA Network Open, 3(10), e2019364. https://doi.org/10.1001/jamanetworkopen.2020.19364
Lu, Y., Chen, R., Cai, J., Huang, Z., & Yuan, H. (2018). The management of hypertension in women planning for pregnancy. British Medical Bulletin, 128(1), 75–84. https://doi.org/10.1093/bmb/ldy035
Markus, A. R., & Pillai, D. (2021). Mapping the location of health centers in relation to “Maternity Care Deserts”: Associations with utilization of women’s health providers and services. Medical Care, 59(Suppl 5), S434–S440. https://doi.org/10.1097/MLR.0000000000001611
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2019). Births: Final data for 2018. National Vital Statistics Reports: FRom the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 68(13), 1–47.
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2021). Births: Final Data for 2019. National Vital Statistics Reports: FRom the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 70(2), 1–51.
Martin, J. A., Osterman, M. J. K., Kirmeyer, S. E., & Gregory, E. C. W. (2015). Measuring gestational age in vital statistics data: Transitioning to the obstetric estimate. National Vital Statistics Reports: FRom the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 64(5), 1–20.
Nawabi, F., Krebs, F., Vennedey, V., Shukri, A., Lorenz, L., & Stock, S. (2021). Health literacy in pregnant women: A systematic review. International Journal of Environmental Research and Public Health, 18(7), 3847. https://doi.org/10.3390/ijerph18073847
Osterman, M. J. K., & Martin, J. A. (2018). Timing and Adequacy of prenatal care in the United States, 2016. National Vital Statistics Reports: FRom the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 67(3), 1–14.
Park, J.-H., Vincent, D., & Hastings-Tolsma, M. (2007). Disparity in prenatal care among women of colour in the USA. Midwifery, 23(1), 28–37. https://doi.org/10.1016/j.midw.2005.08.002
Power, M. L., Wilson, E. K., Hogan, S. O., Loft, J. D., Williams, J. L., Mersereau, P. W., & Schulkin, J. (2013). Patterns of preconception, prenatal and postnatal care for diabetic women by obstetrician-gynecologists. The Journal of Reproductive Medicine, 58(1–2), 7–14.
Robbins, C., Boulet, S. L., Morgan, I., D’Angelo, D. V., Zapata, L. B., Morrow, B., Sharma, A., & Kroelinger, C. D. (2018). Disparities in preconception health indicators—behavioral risk factor surveillance system, 2013–2015, and pregnancy risk assessment monitoring system, 2013–2014. Morbidity and Mortality Weekly Report Surveillance Summaries (washington, D.c.: 2002), 67(1), 1–16. https://doi.org/10.15585/mmwr.ss6701a1
Roman, L. A., Raffo, J. E., Dertz, K., Agee, B., Evans, D., Penninga, K., Pierce, T., Cunningham, B., & VanderMeulen, P. (2017). Understanding perspectives of African American medicaid-insured women on the process of perinatal care: An opportunity for systems improvement. Maternal and Child Health Journal, 21(Suppl 1), 81–92. https://doi.org/10.1007/s10995-017-2372-2
Rui, P., & Okeyode, T. (2015). National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. Available from: http://www.cdc.gov/nchs/ahcd/ahcd_products.htm
Seely, E. W., & Ecker, J. (2014). Chronic hypertension in pregnancy. Circulation, 129(11), 1254–1261. https://doi.org/10.1161/CIRCULATIONAHA.113.003904
Shah, J. S., Revere, F. L., & Toy, E. C. (2018). Improving rates of early entry prenatal care in an underserved population. Maternal and Child Health Journal, 22(12), 1738–1742. https://doi.org/10.1007/s10995-018-2569-z
Sina, M., MacMillan, F., Dune, T., Balasuriya, N., Khouri, N., Nguyen, N., Jongvisal, V., Lay, X. H., & Simmons, D. (2018). Development of an integrated, district-wide approach to pre-pregnancy management for women with pre-existing diabetes in a multi-ethnic population. BMC Pregnancy and Childbirth, 18(1), 402. https://doi.org/10.1186/s12884-018-2028-2
Tolson, G. C., Barnes, J. M., Gay, G. A., & Kowaleski, J. L. (1991). The 1989 revision of the US standard certificates and reports. Vital and Health Statistics. Ser. 4 Documents and Committee Reports, 28, 1–34.
Weisband, Y. L., Gallo, M. F., Klebanoff, M., Shoben, A., & Norris, A. H. (2018). Who uses a midwife for prenatal care and for birth in the United States? A secondary analysis of listening to mothers III. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 28(1), 89–96. https://doi.org/10.1016/j.whi.2017.07.004
Funding
No funds, Grants, or other support was received.
Author information
Authors and Affiliations
Contributions
SJB contributed to the study conception and design, analyzed the data, interpreted the data, and drafted the manuscript. LRBH contributed to the study conception and design, interpreted the data, and edited the manuscript. Both authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no known conflict of interests to disclose.
Ethics Approval
This study used a secondary, publicly available dataset which did not require local institutional review board (IRB) approval.
Consent to Participate
Consent was given to the trained health care worker at the time to complete the Facility Worksheets for the Certificate of Live Birth and Report.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Butts, S.J., Huber, L.R.B. Pre-pregnancy Diabetes, Pre-pregnancy Hypertension and Prenatal Care Timing among Women in the United States, 2018. Matern Child Health J 26, 2300–2307 (2022). https://doi.org/10.1007/s10995-022-03531-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-022-03531-1