Research
Obstetrics
Late recognition of pregnancy as a predictor of adverse birth outcomes

Presented at the National State of the Science Congress on Nursing Research, Washington, DC, Oct. 2-4, 2008.
https://doi.org/10.1016/j.ajog.2009.05.011Get rights and content

Objective

We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality.

Study Design

A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX).

Results

Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21).

Conclusion

These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.

Section snippets

Study design

This study was a secondary analysis of 5 annual data cohorts (2000-2004) collected through the PRAMS program in the United States. The PRAMS data are derived from an ongoing, cross-sectional, population-based survey designed by the Centers for Disease Control and Prevention (CDC).12, 13, 14, 15 The data are representative of women of childbearing age in 29 US states, who had live births within the 2-6 months prior to being contacted for participation in the study.

The PRAMS data are also linked

Results

The mean age of women in the study population was 27 years. The women were predominantly non-Hispanic white (65.6%) and married (67.1%). A substantial percentage of the population (41.2%) was comprised of first-time mothers (had no prior birth). About 40% of the women received Medicaid sometime before or during their pregnancy, and 44% were on public assistance. Fourteen percent of the women continued to smoke during pregnancy, and 6.1% drank alcohol during their third trimester.

Recognition of

Comment

Late recognition of pregnancy was significantly associated with adverse birth outcomes, including increased odds of preterm birth, LBW, and NICU admission. The associations between the time of pregnancy recognition and adverse birth outcomes might appear moderate, with odds ratios usually not deviating from unity by more than 10%. However, it is important to note that these odds ratios reflect associations after adjusting for smoking, drinking, and other variables known to be associated with

Acknowledgments

We acknowledge the suggestions and guidance provided by Larry Hembroff, Audrey Gift, Renee Canady, and Linda Spence, of Michigan State University, during the design and analysis of this study. The authors also acknowledge the support of all the PRAMS Working Groups: Alabama, Albert Woolbright, PhD; Alaska, Kathy Perham-Hester, MS, MPH; Arkansas, Gina Redford, MAP; Colorado, Alyson Shupe, PhD; Florida, Helen Marshall; Georgia, Carol Hoban, MS, MPH; Hawaii, Limin Song, MPH, CHES; Illinois,

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    This study was supported in part by the American Nurses Foundation/Midwest Nursing Research Society, Blue Cross Blue Shield of Michigan Foundation, and Michigan State University.

    Cite this article as: Ayoola AB, Stommel M, Nettleman MD. Late recognition of pregnancy as a predictor of adverse birth outcomes. Am J Obstet Gynecol 2009;201:156.e1-6.

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