Maternal and Child Health Journal

, Volume 16, Issue 1, pp 60–71

Chronic Diseases and Related Risk Factors among Low-Income Mothers

  • Jennifer M. Bombard
  • Patricia M. Dietz
  • Christine Galavotti
  • Lucinda J. England
  • Van T. Tong
  • Donald K. Hayes
  • Brian Morrow


The aim is to describe the burden of chronic disease and related risk factors among low-income women of reproductive age. We analyzed population-based data from the 2005–2006 Pregnancy Risk Assessment Monitoring System (PRAMS) for 14,990 women with a live birth in 7 states. We examined the prevalence of selected chronic diseases and related risk factors (preexisting diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, obesity, smoking or binge drinking prior to pregnancy, smoking or excessive weight gain during pregnancy, and postpartum depressive symptoms) by Federal Poverty Level (FPL) (≤100% FPL; 101–250% FPL; >250% FPL). Approximately one-third of women were low-income (≤100% FPL), one-third were near-low-income (101–250% FPL), and one-third were higher-income (>250% FPL). Compared to higher-income women, low-income women were significantly more likely to smoke before or during pregnancy (34.2% vs. 14.4%, and 24.8% vs. 5.4%, respectively), be obese (22.2% vs. 16.0%), experience postpartum depressive symptoms (23.3% vs. 7.9%), have 3 or more chronic diseases and/or related risk factors (28.1% vs. 14.4%) and be uninsured before pregnancy (48.9% vs. 4.8%). Low-income women of reproductive age experienced a higher prevalence of selected chronic diseases and related risk factors. Enhancing services for these women in publicly-funded family planning clinics may help reduce disparities in pregnancy and long-term health outcomes in the poor.


Pregnancy Chronic diseases Prevalence Poverty 


  1. 1.
    Centers for Disease Control and Prevention. (2006). WISQARS: 10 leading causes of Death, United States, 2006, females. (Retrieved 18 February 2010)
  2. 2.
    Viera, A., Thorpe, J., & Garrett, J. (2006). Effects of sex, age, and visits on receipt of preventive healthcare services: A secondary analysis of national data. BMC Health Services Research, 6(15), 1–8.Google Scholar
  3. 3.
    Agency for Healthcare Research and Quality. (2006). Characteristics of uninsured young adults: Estimates for the US civilian non-institutionalized population, 1923 years of age. (Retrieved 18 February 2010)
  4. 4.
    Frost, J., Finer, L., & Tapales, L. (2008). The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings. Journal of Health Care for the Poor and Underserved, 19(3), 778–796.PubMedCrossRefGoogle Scholar
  5. 5.
    Gold, R. (2001). Title X: Three decades of accomplishment. The Guttmacher Report on Public Policy, 4(1), 5–8.Google Scholar
  6. 6.
    Centers for Disease Control and Prevention. (2009). Health, United States, 2009. (Retrieved 29 September 2010)
  7. 7.
    Shulman, H., Gilbert, B., & Lansky, A. (2006). The Pregnancy Risk Assessment Monitoring System (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74–83.PubMedGoogle Scholar
  8. 8.
    National Institutes of Health, National Heart, Lung, and Blood Institute. (1998). NHLBI Obesity Education Project. (Retrieved 9 December 2009) .
  9. 9.
    Institute of Medicine. (2009). Weight Gain During Pregnancy: Reexaming the Guidelines. (Retrieved 16 February 2010).
  10. 10.
    Kaeser, L., Gold, R., & Richards, C. (1996). Title X at 25: Balancing national family planning needs with state flexibility (pp. 1–28). New York City: The Alan Guttmacher Institute.Google Scholar
  11. 11.
    Kim, V., Dietz, P., England, L., Morrow, B., & Callaghan, B. (2007). Trends in pre-pregnancy obesity in nine states, 1993–2003. Obesity, 15(4), 986–993.PubMedCrossRefGoogle Scholar
  12. 12.
    Tong, V., Jones, J., Dietz, P., D’Angelo, D., & Bombard, J. (2009). Trends in smoking before during and after pregnancy—Pregnancy Risk Assessment Monitoring System (PRAMS) United States 32 sites 2000–2005. Morbidity and Mortality Weekly Report, 58(4), 1–29. [Surveillance Summary].Google Scholar
  13. 13.
    Ahluwalia, I., Mack, K., & Mokdad, A. (2005). Report from the CDC: Changes in selected chronic disease-related risks and health conditions for nonpregnant women 18–44 years old BRFSS. Journal of Women’s Health, 14(5), 382–386.PubMedCrossRefGoogle Scholar
  14. 14.
    Centers for Disease Control, Prevention. (2008). Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses-United States, 2000–2004. Morbidity and Mortality Weekly Report, 57(45), 1226–1228.Google Scholar
  15. 15.
    United States Department of Health & Human Services, Public Health Service. (2008). Treating tobacco use & dependence: 2008 update. (Retrieved 18 February 2010)
  16. 16.
    United States Department of Health & Human Services. (2004). The health consequences of smoking, A report of the surgeon general. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  17. 17.
    Whooley, M., Avins, A., Miranda, J., & Browner, W. (1997). Case finding instruments for depression. Two questions are as good as many. Journal of General Internal Medicine, 12(7), 439–445.PubMedCrossRefGoogle Scholar
  18. 18.
    Beck, C. (1995). The effects of postpartum depression on maternal-infant interaction: A meta-analysis. Nursing Research, 44(5), 298–304.PubMedCrossRefGoogle Scholar
  19. 19.
    Field, T. (1992). Infants of depressed mothers. Development and Psychopathology, 4, 49–66.CrossRefGoogle Scholar
  20. 20.
    Phillips, L., & O’Hara, M. (1991). Prospective study of postpartum depression: 4 ½-year follow-up of women and children. Journal of Abnormal Psychology, 100(2), 151–155.CrossRefGoogle Scholar
  21. 21.
    United States Preventive Task Force. (2002). Screening for depression: recommendations and rationale. (Retrieved 18 February 2010)
  22. 22.
    Wang, P., Berglund, P., & Kessler, R. (2000). Recent care of common mental disorders in the United States: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15(5), 284–292.PubMedCrossRefGoogle Scholar
  23. 23.
    Miranda, J., Chung, J., Green, B., Krupnick, J., & Siddique, J. (2003). Treating depression in predominantly low-income young minority women. Journal of the American Medical Association, 290(1), 57–65.PubMedCrossRefGoogle Scholar
  24. 24.
    Keppel, K., & Taffel, S. (1993). Pregnancy-related weight gain and retention: Implications of the 1990 Institute of Medicine guidelines. American Journal of Public Health, 83(8), 1100–1103.PubMedCrossRefGoogle Scholar
  25. 25.
    Olson, C., Strawderman, M., Hinton, P., & Pearson, T. (2003). Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 year postpartum. International Journal of Obesity and Related Metabolic Disorders, 27(1), 117–127.PubMedCrossRefGoogle Scholar
  26. 26.
    Glazer, N., Hendrickson, A., Schellenbaum, G., & Mueller, B. (2004). Weight change and the risk of gestational diabetes in obese women. Epidemiology, 15(6), 733–737.PubMedCrossRefGoogle Scholar
  27. 27.
    Gunderson, E., & Abrams, B. (2000). Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiological Review, 22(2), 261–274.Google Scholar
  28. 28.
    Villamor, E., & Cnattingius, S. (2006). Interpregnancy weight change and risk of adverse pregnancy outcomes: A population-based study. The Lancet, 368(9542), 1164–1170.CrossRefGoogle Scholar
  29. 29.
    Amerim, A., Linne, Y., & Lourenco, P. (2007). Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database of Systematic Reviews, 3, 1–40.Google Scholar
  30. 30.
    Kuhlmann, A., Dietz, P., Galavotti, C., & England, L. (2008). Weight-management interventions for pregnant or postpartum women. American Journal of Preventive Medicine, 34(6), 523–528.PubMedCrossRefGoogle Scholar
  31. 31.
    Teixeira, P., Silva, M., Coutinho, S., Palmeira, A., & Matu, J. (2010). Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity, 18(4), 725–735.PubMedCrossRefGoogle Scholar
  32. 32.
    Association, American. Diabetes. (2009). Standards of medical care in diabetes—2009. Diabetes Care, 32(Suppl 1), S13–S61.CrossRefGoogle Scholar
  33. 33.
    Gillies, C., Abrams, K., Lambert, P., Cooper, N., Sutton, N., et al. (2007). Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: Systematic review and meta-analysis. British Medical Journal, 334(7588), 299.PubMedCrossRefGoogle Scholar
  34. 34.
    England, L., Dietz, P., Njorge, T., Callaghan, W., & Bruce, C. (2009). Preventing type 2 diabetes: Public health implications for women with a history of gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 200(4), 365e1–365e8.CrossRefGoogle Scholar
  35. 35.
    Haddad, B., & Sibai, B. (1999). Chronic hypertension in pregnancy. Annals of Medicine, 31, 246–252.PubMedCrossRefGoogle Scholar
  36. 36.
    Leeman, L., & Fontaine, P. (2008). Hypertensive disorders of pregnancy. American Family Physician, 78(1), 93–100.PubMedGoogle Scholar
  37. 37.
    Chobanian, A., Bakris, B., Black, H., Cushman, W., Green, L., et al. (2003). Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Journal of the American Medical Association, 289(19), 2560–2572.PubMedCrossRefGoogle Scholar
  38. 38.
    Garovic, V. (2000). Hypertension in pregnancy: Diagnosis and treatment. Mayo Clinic Proceedings, 75(10), 1017–1076.CrossRefGoogle Scholar
  39. 39.
    Kaaja, R., & Greer, I. (2005). Manifestations of chronic disease during pregnancy. Journal of the American Medical Association, 294(21), 2751–2757.PubMedCrossRefGoogle Scholar
  40. 40.
    Smith, G., Walker, M., Liv, A., Wen, S., Swansburg, M., et al. (2009). A history of preeclampsia identifies women who have underlying cardiovascular risk factors. American Journal of Obstetrics and Gynecology, 200(1), 58e1–58e8.CrossRefGoogle Scholar
  41. 41.
    Mosca, L., Banka, C., Benjamin, E., Berra, K., Bushnell, C., et al. (2007). Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Journal of the American College of Cardiology, 49(11), 1230–1250.PubMedCrossRefGoogle Scholar
  42. 42.
    Zhao, G., Wu, C., Houston, R. J., & Creager, W. (2010). The effects of binge drinking and socio-economic status on sober drinking behavior. Traffic Injury Prevention, 11, 342–352.PubMedCrossRefGoogle Scholar
  43. 43.
    Puddey, I., Rakic, V., Dimmit, B., & Beilin, L. (1999). Influence of pattern of drinking on cardiovascular disease and cardiovascular risk factors—a review. Addiction, 94(5), 649–663.PubMedCrossRefGoogle Scholar
  44. 44.
    Rehm, J., Room, R., Graham, K., Monteiro, M., Gmel, G., et al. (2003). The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction, 98(9), 1209–1228.PubMedCrossRefGoogle Scholar
  45. 45.
    Cable, N., & Sacker, A. (2008). Typologies of alcohol consumption in adolescence: Predictors and adult outcomes. Alcohol and Alcoholism, 43(1), 81–90.PubMedCrossRefGoogle Scholar
  46. 46.
    Jennison, K. (2004). The short-term effects and unintended long-term consequences of binge-drinking in college: A 10-year follow-up study. American Journal of Drug and Alcohol Abuse, 30(3), 659–684.PubMedCrossRefGoogle Scholar
  47. 47.
    Viner, R., & Taylor, B. (2007). Adult outcomes of binge drinking in adolescence: Findings from a UK national birth cohort. Journal of Epidemiology and Community Health, 61(10), 902–907.PubMedCrossRefGoogle Scholar
  48. 48.
    Bruce, F., Adams, M., & Shulman, H. (1993). Alcohol use before and during pregnancy. American Journal of Preventive Medicine, 9(5), 267–273.PubMedGoogle Scholar
  49. 49.
    Devlin, H., Desai, J., & Walaszek, A. (2008). Reviewing performance of birth certificate and hospital discharge data to identify births complicated by maternal diabetes. Maternal and Child Health Journal, 13(5), 660–666.PubMedCrossRefGoogle Scholar
  50. 50.
    Lydon-Rochelle, M., Holt, V., Cardenas, V., Nelson, J., Easterling, T., et al. (2005). The reporting of preexisting maternal medical conditions and complications of pregnancy on birth and in hospital discharge data. American Journal of Obstetrics and Gynecology, 193(1), 125–134.PubMedCrossRefGoogle Scholar
  51. 51.
    Gold, R., & Alrich, C. (2008). Role of medicaid family planning waivers and Title X in enhancing access to preconception care. Womens Health Issues, 18(6 Suppl), S47–S51.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2010

Authors and Affiliations

  • Jennifer M. Bombard
    • 1
  • Patricia M. Dietz
    • 1
  • Christine Galavotti
    • 1
  • Lucinda J. England
    • 2
  • Van T. Tong
    • 1
  • Donald K. Hayes
    • 1
  • Brian Morrow
    • 1
  1. 1.Applied Sciences Branch, Division of Reproductive HealthNational Center for Chronic Disease & Health Promotion, Centers for Disease Control & PreventionAtlantaUSA
  2. 2.Maternal and Infant Branch, Division of Reproductive HealthNational Center for Chronic Disease & Health Promotion, Centers for Disease Control & PreventionAtlantaUSA

Personalised recommendations