Impact of Pre-Conception Health Care: Evaluation of a Social Determinants Focused Intervention

Livingood, William C.; Brady, Carol; Pierce, Kimberly; Atrash, Hani K.; Hou, Tao; Bryant, Thomas

doi:10.1007/s10995-009-0471-4

Cited by 29 publications

(24 citation statements)

References 61 publications

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“…The social determinants model emphasizes the powerful influences of lifestyle and the conditions in which people live and work. [3][4][5] Prenatal case management seeks to address social determinants through a range of strategies including psychosocial, nutritional, and health promotion assessment; counseling and referral to public health and social services; and overall care coordination. Several evaluation studies of regional or statewide prenatal case management programs have demonstrated reduction of low birthweight or preterm births among Medicaid recipients after program implementation.…”

Section: Introductionmentioning

confidence: 99%

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Goyal

Hall

Greenberg

et al. 2015

Journal of Women's Health

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Background: Despite prior efforts to develop pregnancy risk prediction models, there remains a lack of evidence to guide implementation in clinical practice. The current aim was to develop and validate a risk tool grounded in social determinants theory for use among at-risk Medicaid patients. Methods: This was a retrospective cohort study of 409 women across 17 Cincinnati health centers between September 2013 and April 2014. The primary outcomes included preterm birth, low birth weight, intrauterine fetal demise, and neonatal death. After random allocation into derivation and validation samples, a multivariable model was developed, and a risk scoring system was assessed and validated using area under the receiver operating characteristic curve (AUROC) values. Results: The derived multivariable model (n = 263) included: prior preterm birth, interpregnancy interval, late prenatal care, comorbid conditions, history of childhood abuse, substance use, tobacco use, body mass index, race, twin gestation, and short cervical length. Using a weighted risk score, each additional point was associated with an odds ratio of 1.57 for adverse outcomes, p < 0.001, AUROC = 0.79. In the validation sample (n = 146), each additional point conferred an odds ratio of 1.20, p = 0.03, AUROC = 0.63. Using a cutoff of 20% probability for the outcome, sensitivity was 29%, with specificity 82%. Positive and negative predictive values were 22% and 85%, respectively. Conclusions: Risk scoring based on social determinants can discriminate pregnancy risk within a Medicaid population; however, performance is modest and consistent with prior prediction models. Future research is needed to evaluate whether implementation of risk scoring in Medicaid prenatal care programs improves clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Goyal

Hall

Greenberg

et al. 2015

Journal of Women's Health

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“…Maternal health is one global health challenges that exhibits dramatic health inequities. Most of the 385,000 maternal deaths occurring each year are concentrated in poor and vulnerable populations and are all the more tragic for being mostly preventable [27]. Maternal health is receiving increased attention in global health, development and human rights agendas and represents a priority area for accelerating progress on the MDGs.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Social Determinants of Health and Pregnancy Outcomes: A Retrospective Cohort Study in Tabriz

Alizadeh

Dastgiri²,

Taghavi

et al. 2014

j clin res gov

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Ab s t r a c tPurpose: To assess the effects of social determinants of health on pregnancy outcome in rural and urban areas of Tabriz.Methods: A retrospective cohort study design was used to examine 600 pregnant women who attended antenatal health care services in Tabriz, Iran from August 2012 to the October 2013. They were followed up from the sixth week of gestation to three months after delivery. Socioeconomic indicators and some other measures such as body mass index, family income status, maternal education and occupation, cigarette smoking, depression, intimate partner violence based upon health ministry guidelines and pregnancy outcomes including low birth weight, small for gestational, and preterm delivery, cesarean delivery and miscarriage were assessed . Results:The mean age of women was 26.1 ± 6.6 years in rural and 27.9 ± 5.7 years in urban areas and the mean duration of pregnancy was 39.03± 1.36 weeks. There was a significant association between maternal education, cesarean section and abortion. BMI played a major role on almost all poor pregnancy outcomes (LBW, PTB, cesarean section, miscarriage) and income status was the first predictor of low birth weight. Socio demographic and behavioral factors were particularly important for predicting miscarriage, preterm labor and low birth weight. Conclusion:Although residential area (rural versus urban of Tabriz) was associated with preterm labor, low birth weight and cesarean section , only cesarean section had a significant effect after adjusting for confounding factors such as income and education level, age, parity, obstetrical complications .Disparity in distribution of resources in rural and urban area were the main factors that made the pregnancy complicated in our study.

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“…Early evaluations demonstrate successful risk reduction with improved family planning and reduced STDs for program participants and marginally statistically significant improvements in low birth weight (Biermann et al 2006;Livingood et al 2010). Additional research is needed to determine the impact of social and health interventions beginning before pregnancy.…”

Section: Early Intervention Studiesmentioning

confidence: 99%

Health Disparities: A Life Course Health Development Perspective and Future Research Directions

Russ¹,

Kahn

Flores

et al. 2017

Handbook of Life Course Health Development

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Historically, research examining health status disparities between members in different socioeconomic status and racial/ethnic groups often focused on adults and the concurrent lifestyle factors that might explain health differentials. Recent years have witnessed an explosion of interest in the developmental origins of adult health and disease, and life course-oriented research has proliferated across the social, biological, and health sciences. This chapter describes how an integrated life course health development framework can be applied to advance our understanding of the dynamic and multilevel processes contributing to health disparities across lifetimes and even generations. Examples of recent research that has examined health status disparities from a life course perspective are provided, and research gaps and challenges are reviewed. The chapter concludes with a set of recommendations for a more strategic and responsive life course-informed research agenda that not only can fill in gaps in current knowledge, but also pave the way for the translation of this knowledge into improvement in practice, programs, and policy aimed at alleviating health disparities.

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Impact of Pre-Conception Health Care: Evaluation of a Social Determinants Focused Intervention

Cited by 29 publications

References 61 publications

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

The Relationship between Social Determinants of Health and Pregnancy Outcomes: A Retrospective Cohort Study in Tabriz

Health Disparities: A Life Course Health Development Perspective and Future Research Directions

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