Chronic health conditions impact health throughout the life course, and their increase in prevalence in recent years has made them a public health priority. Chronic conditions affect about one-third of individuals of childbearing age and increase the risk of adverse pregnancy outcomes—however, the examination of modifiable health factors and multimorbidity on adverse perinatal outcomes, and patterns of postpartum healthcare use are less understood in this population. This dissertation aims to address these research areas to further understand the impact of chronic conditions in the preconception, perinatal, and postpartum period.
Study 1 describes trends in sociodemographic and periconceptional behavioral health factors among individuals with pre-pregnancy chronic conditions and their association with preterm delivery and small-for-gestational age (SGA) using U.S., population-based case-control studies. From 1997–2001 to 2014–2019, the prevalence of pre-pregnancy conditions increased across all sociodemographic groups. Prevalence of unintended pregnancy and delayed prenatal care remained consistent across the study period and did not vary by chronic condition status; while increases in folic acid use and decreases in smoking were observed, with a higher prevalence among individuals with chronic conditions. Non-Hispanic Black and Hispanic/Latine individuals, regardless of chronic condition status, more frequently reported delayed prenatal care and unintended pregnancy, and lower prevalence of folic acid use. Individuals with a pre-pregnancy body mass index of 18.5–24.9 kg/m2 had reduced odds of preterm delivery, while intended pregnancy, folic acid use, timely prenatal care, and no smoking reduced the odds of SGA.
Study 2 evaluates the association between multimorbidity and adverse perinatal outcomes; and describes the clustering of chronic conditions using latent class analysis (LCA) among a retrospective delivery cohort from a safety-net hospital. Multimorbidity was associated with increased risks in hypertensive disorders of pregnancy, preterm delivery, low birthweight, stillbirth, placental abruption, and prolonged hospital stay, while no meaningful difference was found for gestational diabetes and intrapartum hemorrhage. LCA resulted in a 3-class model: Class 1 was characterized by mood/anxiety and substance use disorders; Class 2 was defined by higher weight and chronic hypertension; and Class 3 was characterized by reproductive conditions and infertility. Classes were distributed distinctly across sociodemographic sub-groups.
Study 3 examines the relationship between pre-pregnancy chronic conditions and variation, frequency, and timing of postpartum healthcare use in the 60 days after delivery discharge. Overall, 87% of individuals had at least one postpartum visit—74% had a preventative visit, 51% had a problem visit, 16% had an emergency department (ED) visit, and 4% had a hospital readmission. Compared to individuals without chronic conditions, individuals with chronic conditions had a higher risk and frequency of problem visits, ED visits, and hospital readmissions. A majority of individuals had a combination of visit types beyond preventative visits, regardless of chronic condition status. More than half of ED visits and readmissions occurred within the first two weeks postpartum.
The findings of this dissertation highlight the need to reconceptualize reproductive, perinatal, and postpartum models of care that address the complex healthcare needs of individuals with chronic conditions, especially among historically minoritized populations who bear a disproportionate burden of chronic conditions and adverse perinatal outcomes. / 2026-05-16T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/48774 |
| Date | 16 May 2024 |
| Creators | Huezo Garcia, Michelle |
| Contributors | Werler, Martha M |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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