1. 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

2. 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

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

4. 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)

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

6. 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

7. 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

8. 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

9. 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

10. Results: Sociodemographic Variable1 st /2 nd 3 rd p Age30.034.3.00 Prior drug tx3.42.2.10 Gravida4.45.7.02 Term1.83.2.00 Children living w/ woman.761.8.00

11. Results: Psychosocial Variable(%)1 st /2 nd 3 rd p Hx depression 89.2 10.8.02 Hx suicide attempt 89.8 10.2.07 Hx anxiety 88.1 11.9.09 Ever phys abuse 90.5 9.5.01

12. Results: Multivariate: Group VariableAdj OR p Term births1.22.08 Children living with woman1.63.01 No lifetime hx physical abuse2.94.03

13. Results: Multivariate: Age & Race Trimester AA(%) EA(%) X 2 p 1 st /2 nd 75.8 88.9 4.2.04 3 rd 24.2 11.1 Age 18-3021.878.2 54.2.00 31-4681.019.0

14. Results: Multivariate: Caucasian VariableAdj ORp Older age10.2.01 No lifetime history physical abuse4.57.12

15. Results: Multivariate: African American VariableAdj ORp Younger age7.11.03 Children living with woman2.00.00 No history suicide att4.98.08 Gravida1.38.04 # prior drug treatment0.65.02

16. 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?

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