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Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention.

Publication ,  Journal Article
Wheeler, S; DeNoble, A; Wynn, C; Weaver, K; Swamy, G; Janko, M; Lantos, P
Published in: J Racial Ethn Health Disparities
June 2019

INTRODUCTION: To reduce the risk of recurrence, women with a history of spontaneous preterm birth (PTB) are recommended to receive 17-hydroxyprogesterone caproate (17-P) injections starting by the 20th week of pregnancy. In women eligible for 17-P, we aimed to identify patient factors and geospatial locations associated with increased risk of presentation beyond 20 weeks gestation. METHODS: We conducted a secondary analysis of a retrospective cohort study including all women meeting criteria for 17-P within a single academic medical center over a 2-year period. We compared early (< 20 6/7 weeks) with late (> 21 weeks) presenters via demographics, social history, and index pregnancy outcomes using standard and Bayesian statistical models. Geospatial mapping was performed to determine residential areas with high risk for late presentation. RESULTS: Geocoded address data was available for 351 women in whom the mean gestational age at first visit was 14.9 weeks, and 63 of whom were late presenters (17.9%). Younger maternal age, current smoking, and lack of health insurance were predictors of late presentation with greater than 95% probability. Hispanic ethnicity and black race were associated with higher odds of late presentation with 87 and 69% probability, respectively. The area with the latest gestational age at presentation was located within central Durham City and to the northeast. DISCUSSION: Our study identified patient-level risk factors and geographic locations associated with presentation beyond the recommend window for 17-P initiation. These findings suggest an urgent need for intervention to improve early prenatal care initiation and a target location where such interventions will be most impactful.

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Published In

J Racial Ethn Health Disparities

DOI

EISSN

2196-8837

Publication Date

June 2019

Volume

6

Issue

3

Start / End Page

563 / 569

Location

Switzerland

Related Subject Headings

  • United States
  • Smoking
  • Secondary Prevention
  • Risk Factors
  • Retrospective Studies
  • Racial Groups
  • Prenatal Care
  • Premature Birth
  • Pregnancy
  • Insurance, Health
 

Citation

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ICMJE
MLA
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Wheeler, S., DeNoble, A., Wynn, C., Weaver, K., Swamy, G., Janko, M., & Lantos, P. (2019). Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention. J Racial Ethn Health Disparities, 6(3), 563–569. https://doi.org/10.1007/s40615-018-00555-8
Wheeler, Sarahn, Anna DeNoble, Clara Wynn, Kristin Weaver, Geeta Swamy, Mark Janko, and Paul Lantos. “Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention.J Racial Ethn Health Disparities 6, no. 3 (June 2019): 563–69. https://doi.org/10.1007/s40615-018-00555-8.
Wheeler S, DeNoble A, Wynn C, Weaver K, Swamy G, Janko M, et al. Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention. J Racial Ethn Health Disparities. 2019 Jun;6(3):563–9.
Wheeler, Sarahn, et al. “Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention.J Racial Ethn Health Disparities, vol. 6, no. 3, June 2019, pp. 563–69. Pubmed, doi:10.1007/s40615-018-00555-8.
Wheeler S, DeNoble A, Wynn C, Weaver K, Swamy G, Janko M, Lantos P. Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention. J Racial Ethn Health Disparities. 2019 Jun;6(3):563–569.
Journal cover image

Published In

J Racial Ethn Health Disparities

DOI

EISSN

2196-8837

Publication Date

June 2019

Volume

6

Issue

3

Start / End Page

563 / 569

Location

Switzerland

Related Subject Headings

  • United States
  • Smoking
  • Secondary Prevention
  • Risk Factors
  • Retrospective Studies
  • Racial Groups
  • Prenatal Care
  • Premature Birth
  • Pregnancy
  • Insurance, Health