Disparity in Patient-Provider Communication among Pregnant Latinas Apprentice Apprentice: Bonnie Young, MA, MPH Mentor Mentor: Ludmila Bakhireva, MD, PhD, MPH SMART Study collaboration: W. Rayburn, S. Phelan, A. Rowland, P. Sarangarm, P. Jaiswal, and UNM-affiliated prenatal care clinics Apprenticeship funded by the UNM HSC Signature Program in Child Health Research

Background ChallengeChallenge: Optimal and safe treatment of maternal disease during pregnancy Medications in pregnancyMedications in pregnancy: Contraindicated exposure (FDA category D or X) Underuse (chronic conditions) Maternal knowledge and communication with providers crucial factors Health disparities Health disparities: Ethnic minorities experience disparities in communication with providers (Paasche-Orlow & Wolf 2007; Dedier et al., 1999) Limited information among pregnant Latinas

Research Questions & Methods perceptions about risks of birth defects from medications 1.What are pregnant women’s perceptions about risks of birth defects from medications? disparity in provider communication 2.Do pregnant Latinas experience disparity in provider communication? Sample population: 200 pregnant women at 4 UNM- affiliated clinics –Interviews in English and Spanish –Lifestyle, socio-demographic, medical history –Medical history validated by Power Chart Table 1. Participant characteristics (N = 200) Maternal age27.2 yrs ± 5.8 Gestational age31.3 wks ± 7.7 Hispanic ethnicity78% Non-U.S. born55% Spanish speaking57% Married, living with partner71% Education: < high school degree33% No health insurance42% Never smoked72% Chronic condition(s)44% History of adverse perinatal outcomes37%

(1) Sources of Information 75% inquired about safety of medications 35% believed medications cause birth defects “often, very often, or always” (2) Perceptions of Teratogenicity

Ethnicity Education Insurance status Place of birth Prenatal clinic location Language spoken at home Existing chronic condition Predictors of Lack of Inquiry (Multivariate Logistic Regression) Hispanic ethnicity (OR 4.8, 95% CI 1.0, 21.7) No insurance (OR 3.7, 95% CI 1.1, 12.7) Chronic condition (OR 0.3, 95% CI 0.2, 0.8)

Conclusions & Discussion Disparity in communication Latinas No health insurance Inaccurately high perception of teratogenic risk of medications May prevent women from taking necessary medications Strengths and limitations Future research –Focus groups –Fetal and maternal outcomes –Culturally-sensitive interventions South Broadway Clinic