Factors Associated with Third Trimester Prenatal Care among Women in Drug Treatment

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

10. Results: Sociodemographic Variable 1st/2nd 3rd p Age 30.0 34.3 .00 Prior drug tx 3.4 2.2 .10 Gravida 4.4 5.7 .02 Term 1.8 3.2 .00 Children living w/ woman .76 1.8 .00

11. Results: Psychosocial Variable(%) 1st/2nd 3rd 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 Variable Adj OR p Term births 1.22 .08 Children living with woman 1.63 .01 No lifetime hx physical abuse 2.94 .03

13. Results: Multivariate: Age & Race Trimester AA(%) EA(%) X2 p 1st/2nd 75.8 88.9 4.2 .04 3rd 24.2 11.1 Age 18-30 21.8 78.2 54.2 .00 31-46 81.0 19.0

14. Results: Multivariate: Caucasian Variable Adj OR p Older age 10.2 .01 No lifetime history physical abuse 4.57 .12

15. Results: Multivariate: African American Variable Adj OR p Younger age 7.11 .03 Children living with woman 2.00 .00 No history suicide att 4.98 .08 Gravida 1.38 .04 # prior drug treatment 0.65 .02

16. Conclusions • More term births/children associated w/ late prenatal care • Significance of age may vary w/ race • 1st 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