Factors Associated with Third Trimester Prenatal Care among Women in Drug Treatment Benita Walton-Moss, DNS Jessica Conrad, MSN Johns Hopkins University.

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Factors Associated with Third Trimester Prenatal Care among Women in Drug Treatment Benita Walton-Moss, DNS Jessica Conrad, MSN Johns Hopkins University Linda McIntosh, PhD North Carolina Agricultural and Technical State University

Background 2003: 3.5% women initiated care in 3 rd trimester or obtained no prenatal care Risk factors: age < 20 yrs, unmarried, low education, Hispanic or African American race/ethnicity, illicit drug use

Study Aim Identify factors associated with third trimester prenatal care among drug- dependent women in substance abuse treatment

Methods Secondary analysis from larger investigation of individual & environmental factors and birth outcome of pregnant women with substance use disorders One-time face-to-face interview within 1 st week of treatment Sociodemographic questions, SF-36, & Brief Symptom Inventory (BSI)

Setting Comprehensive multidisciplinary treatment: substance abuse, mental health, obstetrical-gynecologic, & pediatric care Treatment begins with 7 days residential care followed by intensive outpatient treatment

Eligibility At least 18 yrs of age, pregnant, English- speaking, admitted for substance abuse treatment Excluded if postpartum, in acute psychiatric distress or court-mandated to treatment

Statistical Analysis Bivariate: chi-square, t-tests, simple logistic regression Multivariate: multiple logistic regression –Variables eligible if p <.10 –Backward, stepwise approach –Variables retained in final model if p <.15

Sample 155 women Mean age 31 years 52% African American 96.6% unemployed 67.7% unmarried Most treated for substance dependence at least once before 68.4% heroin major drug of abuse

Results 18.7% initiated care in 3 rd trimester 41.9% initiated care in 2 nd trimester 39.4% initiated care in 1 st trimester

Results: Sociodemographic Variable1 st /2 nd 3 rd p Age Prior drug tx Gravida Term Children living w/ woman

Results: Psychosocial Variable(%)1 st /2 nd 3 rd p Hx depression Hx suicide attempt Hx anxiety Ever phys abuse

Results: Multivariate: Group VariableAdj OR p Term births Children living with woman No lifetime hx physical abuse

Results: Multivariate: Age & Race Trimester AA(%) EA(%) X 2 p 1 st /2 nd rd Age

Results: Multivariate: Caucasian VariableAdj ORp Older age No lifetime history physical abuse

Results: Multivariate: African American VariableAdj ORp Younger age Children living with woman No history suicide att Gravida # prior drug treatment

Conclusions More term births/children associated w/ late prenatal care Significance of age may vary w/ race 1 st published investigation suggesting association of no lifetime history of physical abuse and late prenatal care –Help-seeking? –Associated w/ prior drug treatment?

Limitations & further questions Secondary analysis Varying age distribution by race Appropriateness of study questionnaires –Lack of more appropriate standardized questionnaires