PC1063: Does Preconception Care Screening Differ by Race or Ethnicity?

Background: Although preconception care screening (PCCS) is recommended, only 30% of women report having received any PCCS and racial/ethnic disparities exist. Many previous studies do not account for other social determinants of health(SDH) which may impact PCCS such as substance use or adverse life events. Further, little is known about specific aspects of PCCS such as counseling for family history, diabetes, and hypertension by race/ethnicity. Therefore, we sought to assess features of PCCS among a unique study population where race/ethnicity and SDH are collected via self-report. Our objective was to determine if maternal race/ethnicity is associated with differences in receiving PCCS for diabetes, high blood pressure or assessment of family medical history controlling for SDH.

Methods: Cross-sectional survey responses merged with birth certificate data were collected from 2016-2021 from mothers (≥ 18 years) of singleton live-born infants. Women were stratified into 4 self-reported racial/ethnic groups: Non-Hispanic White(NHW), Non-Hispanic Black(NHB), Hispanic, or Other. Outcomes included self-reported assessment for diabetes, hypertension and discussion of family medical history in the 12 months before pregnancy. Bivariate analysis evaluated differences in PCCS and demographic information by race/ethnicity. Logistic regression assessed PCCS by racial/ethnic groups controlling for age, marital status, education, substance use, adverse life events, exercise, insurance status, and preexisting diabetes and hypertension.

Results: 1,053 women were included, 387(37%) identified as NHW, 186(17%) as NHB, 423(40%) as Hispanic, and 57(5%) as Other(Table 1). There were 14 women with preexisting diabetes and 20 with hypertension. Women who were employed, had greater than a high school degree, exercised at least 3days a week and with preexisting hypertension had higher rates of PCCS for high blood pressure and family medical history( p < 0.05, Table 2). Women who had preexisting diabetes and those that exercised had significantly higher rates of PCCS for diabetes. Women with preexisting diabetes also had higher rates of PCCS for high blood pressure(p < 0.05). In adjusted analysis, NHB women had higher odds of PCCS for diabetes(OR 2.01, 95% CI [1.26-3.20]), high blood pressure(OR 1.93, 95% CI [1.24-3.01]), and counseling about their family medical history(OR 1.81, 95% CI [1.17-2.80]) compared to NHW women. Hispanic women and Others did not differ in receiving PCCS for diabetes, high blood pressure and counseling about their family medical history compared to NHW in adjusted analysis.

Conclusion: Although NHB women had higher odds of receiving PCCS with respect to diabetes, hypertension and family history, Hispanic women were as likely as NHW women to receive PCCS despite being a high risk population for these conditions. Absence of higher screening rates in Hispanic women may represent a novel healthcare disparity. Awareness may need to be raised about enhanced PCCS for Hispanic women due to an increased risk for chronic illnesses.