Interconception Care Utilization: Predictors, Barriers and Birth Outcomes

After decades of focusing solely on prenatal care interventions; the CDC and the March of Dimes convened a national summit in 2006 to discuss an agenda for preconception care programs, research, and policy. During this discussion, one of the noted recommendations highlighted that “the interconception period should be used to provide additional intensive interventions to women who have had a previous pregnancy that ended in an adverse outcome.” However, despite national recommendations regarding the use of interconception care, many high risk women do not receive the health services, care and counseling needed during the interconception period. To add to the literature on how interconception care is measured, its use among those who most need it, possible barriers to care and its association with subsequent birth outcome; this dissertation was divided into three studies with each study focusing on one research question. Study 1 question: What risk factors are associated with self-reported receipt of interconception care? Study 2 question: What risk factors are associated with health insurance coverage during the interconception period? Study 3 question: What is the association between interconception care and subsequent birth outcome? These studies are relevant because of gaps in the literature regarding the utilization of interconception care at a population level. They are also relevant because current maternal and child health data show that women who experience noted risk factors (including having a previous adverse birth outcome) are significantly more likely to have adverse birth outcomes in future pregnancies. The Pregnancy Response Assessment Monitoring System (PRAMS) national dataset was used in all three studies. The data used in this dissertation was collected from 2009 to 2013, and 33 states participated during this data collection period. In the first study, multivariate logistic regression models were used. The models showed that high risk women including those who reported that they were African American, diabetic, hypertensive, obese, and had a previous adverse birth outcome were more likely to receive interconception care. Multinomial regression models were used in studies’ 2 and 3. Results from study 2 showed that high risk women including those who reported that they were African American, hypertensive, diabetic and had a previous adverse birth outcome were more likely to be on Medicaid than to be uninsured. And results from study 3 showed that women who adhered to interconception care recommendations regarding a healthy diet and regular exercise were less likely to have a premature and low birth weight infant than a healthy infant. Overall, these three studies confirm that women who report noted risk factors are more likely to experience repeat adverse birth outcomes if these factors are not addressed. This emphasizes the importance of interconception care for high risk women in the form of tailored care/services that can tackle the socioeconomic and health problems that increase their risk for adverse birth outcomes. Furthermore, the three studies highlight that targeted interventions must also address systemic barriers to care if they are to reduce national rates of adverse birth outcomes and infant mortality