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ABSTRACT: OBJECTIVE: Prepregnancy to postpregnancy change in weight, body mass index (BMI), waist circumference, diet, and physical activity in women with and without gestational diabetes mellitus (GDM) were compared. DESIGN AND METHODS: Using the Coronary Artery Risk Development in Young Adults study, women with at least one pregnancy during 20 years of follow-up (n = 1,488 with 3,125 pregnancies) was identified. Linear regression with generalized estimating equations to compare prepregnancy to postpregnancy changes in health behaviors and anthropometric measurements between 137 GDM pregnancies and 1,637 non-GDM pregnancies, adjusted for parity, age at delivery, outcome measure at the prepregnancy exam, race, education, mode of delivery, and interval between delivery and postpregnancy examination were used. RESULTS: When compared with women without GDM in pregnancy, women with GDM had higher prepregnancy mean weight (158.3 vs. 149.6 lb, P = 0.011) and BMI (26.7 vs. 25.1 kg/m(2) , P = 0.002), but nonsignificantly lower total daily caloric intake and similar levels of physical activity. Both GDM and non-GDM groups had higher average postpartum weight of 7-8 lbs and decreased physical activity on average 1.4 years after pregnancy. CONCLUSIONS: Both groups similarly increased total caloric intake but reduced fast food frequency. Prepregnancy to postpregnancy changes in body weight, BMI, waist circumference, physical activity, and diet did not differ between women with and without GDM in pregnancy. Following pregnancy, women with and without GDM increased caloric intake, BMI, and weight and decreased physical activity, but reduced their frequency of eating fast food. Given these trends, postpartum lifestyle interventions, particularly for women with GDM, are needed to reduce obesity and diabetes risk.
Obesity 11/2012; · 4.28 Impact Factor
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ABSTRACT: OBJECTIVE: To ensure appropriate allocation of research funds, we need methods for identifying high-priority research needs. We developed and pilot tested a process to identify needs for primary clinical research using a systematic review in gestational diabetes mellitus. STUDY DESIGN AND SETTING: We conducted eight steps: abstract research gaps from a systematic review using the Population, Intervention, Comparison, Outcomes, and Settings (PICOS) framework; solicit feedback from the review authors; translate gaps into researchable questions using the PICOS framework; solicit feedback from multidisciplinary stakeholders at our institution; establish consensus among multidisciplinary external stakeholders on the importance of the research questions using the Delphi method; prioritize outcomes; develop conceptual models to highlight research needs; and evaluate the process. RESULTS: We identified 19 research questions. During the Delphi method, external stakeholders established consensus for 16 of these 19 questions (15 with "high" and 1 with "medium" clinical benefit/importance). CONCLUSION: We pilot tested an eight-step process to identify clinically important research needs. Before wider application of this process, it should be tested using systematic reviews of other diseases. Further evaluation should include assessment of the usefulness of the research needs generated using this process for primary researchers and funders.
Journal of clinical epidemiology 09/2012; · 2.96 Impact Factor
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ABSTRACT: Identification of unanswered research questions about the management of gestational diabetes mellitus (GDM) is necessary to focus future research endeavors. We developed a process for elucidating the highest priority research questions on GDM.
Using a systematic review on GDM as a starting point, we developed an eight-step process: (1) identification of research gaps, (2) feedback from the review's authors, (3) translation of gaps into researchable questions using population, intervention, comparators, outcomes, setting (PICOS) framework, (4) local institutions' stakeholders' refinement of research questions, (5) national stakeholders' use of Delphi method to develop consensus on the importance of research questions, (6) prioritization of outcomes, (7) conceptual framework, and (8) evaluation.
We identified 15 high priority research questions for GDM. The research questions focused on medication management of GDM (e.g., various oral agents vs. insulin), delivery management for women with GDM (e.g., induction vs. expectant management), and identification of risk factors for, prevention of, and screening for type 2 diabetes in women with prior GDM. Stakeholders rated the development of chronic diseases in offspring, cesarean delivery, and birth trauma as high priority outcomes to measure in future studies.
We developed an eight-step process using a multidisciplinary group of stakeholders to identify 15 research questions of high clinical importance. Researchers, policymakers, and funders can use this list to direct research efforts and resources to the highest priority areas to improve care for women with GDM.
Journal of Women s Health 07/2012; 21(9):925-32. · 1.57 Impact Factor
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Maternal and Child Health Journal 11/2011; · 2.24 Impact Factor
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ABSTRACT: To ascertain prepregnancy physical activity and dietary intake from a sample of women in early pregnancy and estimate the effect of prepregnancy lifestyle behaviors on the 1-hour glucose challenge test (GCT).
We conducted a prospective analysis of a racially diverse urban-based sample of 152 pregnant women in the first trimester who were participants in the Parity, Inflammation and Diabetes (PID) study. Dietary intake before pregnancy was assessed using a modified version of the Block Rapid Food Screener, and leisure time physical activity before pregnancy was assessed using the Baecke questionnaire. Test results from a nonfasting oral GCT conducted between 26 and 28 weeks were abstracted from the medical record. Participants were classified as having a positive GCT if the blood glucose measurement was ≥140 mg/dL and as negative with a blood glucose measurement <140 mg/dL. We constructed a series of multiple logistic regression models, adjusting for potential confounders to determine if prepregnancy dietary intake and leisure activity were associated with response to the GCT.
Women with higher prepregnancy leisure activity scores were 68% less likely to have a 1-hour GCT response ≥140mg/dL. However, there was no association between dietary intake and response to the GCT.
Our data suggest that prevention of an abnormal GCT result should include practices to encourage women of reproductive age to engage in leisure physical activity in advance of planning a pregnancy.
Journal of Women s Health 09/2011; 20(12):1847-51. · 1.57 Impact Factor
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Wendy L Bennett,
Nisa M Maruthur,
Sonal Singh,
Jodi B Segal,
Lisa M Wilson,
Ranee Chatterjee,
Spyridon S Marinopoulos,
Milo A Puhan,
Padmini Ranasinghe,
Lauren Block, Wanda K Nicholson,
Susan Hutfless,
Eric B Bass,
Shari Bolen
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ABSTRACT: Given the increase in medications for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices.
To summarize the benefits and harms of metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 receptor agonists, as monotherapy and in combination, to treat adults with type 2 diabetes.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception through April 2010 for English-language observational studies and trials. The MEDLINE search was updated to December 2010 for long-term clinical outcomes.
Two reviewers independently screened reports and identified 140 trials and 26 observational studies of head-to-head comparisons of monotherapy or combination therapy that reported intermediate or long-term clinical outcomes or harms.
Two reviewers following standardized protocols serially extracted data, assessed applicability, and independently evaluated study quality.
Evidence on long-term clinical outcomes (all-cause mortality, cardiovascular disease, nephropathy, and neuropathy) was of low strength or insufficient. Most medications decreased the hemoglobin A(1c) level by about 1 percentage point and most 2-drug combinations produced similar reductions. Metformin was more efficacious than the DPP-4 inhibitors, and compared with thiazolidinediones or sulfonylureas, the mean differences in body weight were about -2.5 kg. Metformin decreased low-density lipoprotein cholesterol levels compared with pioglitazone, sulfonylureas, and DPP-4 inhibitors. Sulfonylureas had a 4-fold higher risk for mild or moderate hypoglycemia than metformin alone and, in combination with metformin, had more than a 5-fold increased risk compared with metformin plus thiazolidinediones. Thiazolidinediones increased risk for congestive heart failure compared with sulfonylureas and increased risk for bone fractures compared with metformin. Diarrhea occurred more often with metformin than with thiazolidinediones.
Only English-language publications were reviewed. Some studies may have selectively reported outcomes. Many studies were small, were of short duration, and had limited ability to assess clinically important harms and benefits.
Evidence supports metformin as a first-line agent to treat type 2 diabetes. Most 2-drug combinations similarly reduce hemoglobin A(1c) levels, but some increased risk for hypoglycemia and other adverse events. Primary Funding Source: Agency for Healthcare Research and Quality.
Annals of internal medicine 03/2011; 154(9):602-13. · 16.73 Impact Factor
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ABSTRACT: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM.
We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management.
Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9 kg/m(2) (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care.
Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk.
Journal of Women s Health 02/2011; 20(2):239-45. · 1.57 Impact Factor
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ABSTRACT: Our objective was to test the hypothesis that intrauterine exposure to gestational diabetes [GDM] predicts childhood growth independent of the effect on infant birthweight. We conducted a prospective analysis of 28,358 mother-infant pairs who enrolled in the National Collaborative Perinatal Project between 1959 and 1965. The offspring were followed until age 7. Four hundred and eighty-four mothers (1.7%) had GDM. The mean birthweight was 3.2 kg (range 1.1-5.6 kg). Maternal characteristics (age, education, race, family income, pre-pregnancy body mass index and pregnancy weight gain) and measures of childhood growth (birthweight, weight at ages 4, and 7) differed significantly by GDM status (all P < 0.05). As expected, compared to their non-diabetic counterparts, mothers with GDM gave birth to offspring that had higher weights at birth. The offspring of mothers with GDM were larger at age 7 as indicated by greater weight, BMI and BMI z-score compared to the offspring of mothers without GDM at that age (all P < 0.05). These differences at age 7 persisted even after adjustment for infant birthweight. Furthermore, the offspring of mothers with GDM had a 61% higher odds of being overweight at age 7 compared to the offspring of mothers without GDM after adjustment for maternal BMI, pregnancy weight gain, family income, race and birthweight [OR = 1.61 (95%CI:1.07, 1.28)]. Our results indicate that maternal GDM status is associated with offspring overweight status during childhood. This relationship is only partially mediated by effects on birthweight.
Maternal and Child Health Journal 02/2011; 16(1):125-32. · 2.24 Impact Factor
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ABSTRACT: Women with a history of gestational diabetes mellitus are at high risk for type 2 diabetes mellitus. We systematically reviewed and synthesized the literature on the sensitivity, specificity, and reproducibility of postpartum screening tests for type 2 diabetes in women with prior gestational diabetes to inform screening guidelines.
We searched electronic databases through October 1, 2008. Two investigators independently reviewed titles, abstracts, and articles, performed serial data abstraction, and independently assessed quality. We calculated standard errors and confidence intervals for sensitivity and specificity using the exact binomial formula.
Eleven studies contained 13 evaluations of a comparison screening test with the 2-h 75-g oral glucose tolerance test (OGTT) reference. All studies used a cross-sectional study design. There were ten comparisons of a single fasting blood glucose (FBG) >=7.0 mmol/L (>=126 mg/dL) with the OGTT. The sensitivity ranged from 14%-100% in five studies using the 1985 World Health Organization's (WHO) criteria as the reference and from 16%-89% in five studies using the 1999 WHO criteria as the reference. Variation in the sensitivities may be due to the limited number of comparisons, differences in populations, and timing of screening. There were high losses to follow-up, limiting generalizability.
When compared with the OGTT, the single FBG alone was not consistently reported to be a sensitive screening test for type 2 diabetes in women with a history of gestational diabetes. Longitudinal studies are needed to address the natural history of glucose metabolism in women with a history of gestational diabetes, the optimal approach to diagnostic testing for type 2 diabetes in this population, and the short-term and long-term outcomes of testing.
Journal of Women s Health 08/2009; 18(7):979-87. · 1.57 Impact Factor
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ABSTRACT: We conducted a systematic review of studies examining risk factors for the development of type 2 diabetes among women with previous gestational diabetes. Our search strategy yielded 14 articles that evaluated 9 categories of risk factors of type 2 diabetes in women with gestational diabetes: anthropometry, pregnancy-related factors, postpartum factors, parity, family history of type 2 diabetes, maternal lifestyle factors, sociodemographics, oral contraceptive use, and physiologic factors. The studies provided evidence that the risk of type 2 diabetes was significantly higher in women having increased anthropometric characteristics with relative measures of association ranging from 0.8 to 8.7 and women who used insulin during pregnancy with relative measures of association ranging between 2.8 and 4.7. A later gestational age at diagnosis of gestational diabetes, >24 weeks gestation on average, was associated with a reduction in risk of development of type 2 diabetes with relative measures of association ranging between 0.35 and 0.99. We concluded that there is substantial evidence for 3 risk factors associated with the risk of type 2 diabetes in women having gestational diabetes.
The American journal of medicine 03/2009; 122(3):207-214.e4. · 4.47 Impact Factor
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ABSTRACT: Women with a history of gestational diabetes mellitus (GDM) are at high risk for type 2 diabetes mellitus (T2DM). Objective: We reviewed prospective studies of antepartum glucose tolerance test results as risk factors for development of T2DM among women with a history of GDM.
We searched 4 electronic databases and hand-searched 13 journals for literature published through January 2007. The search strategy consisted of medical subject headings and text words for GDM, T2DM, and other relevant terms. Articles were excluded for the following reasons: (1) not written in English; (2) no human data; (3) no original data; (4) <90% of sample was diagnosed with GDM without a separate analysis for women with GDM; (5) case report or series; (6) diagnosis of GDM not based on 3-hour 100-g oral glucose tolerance test (OGTT) or 2-hour 75-g OGTT; (7) T2DM not evaluated as outcome; (8) no relative measure of association or incidence reported; or (9) design did not address antepartum OGTT as a predictor of T2DM. Two investigators independently reviewed citations, performed serial data abstraction on full articles, and assessed the quality of each article. Data were abstracted for study participants and characteristics, T2DM diagnosis, length of follow-up, regression model covariates, and measures of association and variability.
Of 11,400 unique citations, we identified 11 articles that evaluated antepartum glucose testing and risk of T2DM in women with a history of GDM. Five studies found that the fasting blood glucose (FBG) on the antepartum diagnostic OGTT was a significant predictor of T2DM (odds ratio [OR] range: 11.1-21.0; relative risk [RR] range: 1.37-1.5; relative hazard [RH] = 2.47). Risk of incident T2DM was predicted by the antepartum 2-hour OGTT plasma glucose in 3 studies (OR range: 1.02-1.03; RR = 1.3) and by the antepartum OGTT glucose AUC in 3 other studies (OR range: 3.64-15; RH = 2.13). Overall, study quality was limited by high losses to follow-up (>20% in 6 studies) and short duration. Few studies adjusted for adiposity, an established diabetes risk factor.
FBG, OGTT 2-hour blood glucose, and OGTT glucose AUC appeared to be strong and consistent predictors of subsequent T2DM among women who met diagnostic criteria for GDM using the OGTT.
Gender Medicine 01/2009; 6 Suppl 1:109-22. · 2.10 Impact Factor
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Wanda K Nicholson,
Lisa M Wilson,
Catherine Takacs Witkop,
Kesha Baptiste-Roberts,
Wendy L Bennett,
Shari Bolen,
Bethany B Barone,
Sherita Hill Golden,
Tiffany L Gary,
Donna M Neale,
Eric B Bass
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ABSTRACT: We focused on four questions: What are the risks and benefits of an oral diabetes agent (i.e., glyburide), as compared to all types of insulin, for gestational diabetes? What is the evidence that elective labor induction, cesarean delivery, or timing of induction is associated with benefits or harm to the mother and neonate? What risk factors are associated with the development of type 2 diabetes after gestational diabetes? What are the performance characteristics of diagnostic tests for type 2 diabetes in women with gestational diabetes?
We searched electronic databases for studies published through January 2007. Additional articles were identified by searching the table of contents of 13 journals for relevant citations from August 2006 to January 2007 and reviewing the references in eligible articles and selected review articles.
Paired investigators reviewed abstracts and full articles. We included studies that were written in English, reported on human subjects, contained original data, and evaluated women with appropriately diagnosed gestational diabetes. Paired reviewers performed serial abstraction of data from each eligible study. Study quality was assessed independently by each reviewer.
The search identified 45 relevant articles. The evidence indicated that: Maternal glucose levels do not differ substantially in those treated with insulin versus insulin analogues or oral agents. Average infant birth weight may be lower in mothers treated with insulin than with glyburide. Induction at 38 weeks may reduce the macrosomia rate, with no increase in cesarean delivery rates. Anthropometric measures, fasting blood glucose (FBG), and 2-hour glucose value are the strongest risk factors associated with development of type 2 diabetes. FBG had high specificity, but variable sensitivity, when compared to the 75-gm oral glucose tolerance test (OGTT) in the diagnosis of type 2 diabetes after delivery.
The evidence suggests that benefits and a low likelihood of harm are associated with the treatment of gestational diabetes with an oral diabetes agent or insulin. The effect of induction or elective cesarean on outcomes is unclear. The evidence is consistent that anthropometry identifies women at risk of developing subsequent type 2 diabetes; however, no evidence suggested the FBG out-performs the 75-gm OGTT in diagnosing type 2 diabetes after delivery.
Evidence report/technology assessment 04/2008;
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ABSTRACT: While high parity is hypothesized to be associated with insulin resistance and type 2 diabetes, few studies have examined this association in diverse racial samples or geographical areas. Our objectives were to estimate the magnitude of association between parity and diabetes and to determine if higher parity is predictive of future risk of diabetes.
This was a population-based, prospective cohort study of 7,024 Caucasian and African-American women from the Atherosclerosis Risk in Communities study, a prospective epidemiological study of men and women aged 45-64 years, with 9 years of follow-up. Incident diabetes was defined by the 1997 American Diabetes Association diagnostic criteria. Parity was defined as the number of live births (no live births [nulliparity], one to two live births, three to four live births, and five or more live births [grandmultiparity]). Parity and risk of diabetes was estimated for 754 incident cases of diabetes with Cox proportional hazard regression models, adjusting for sociodemographic, clinical, and lifestyle factors and inflammatory markers.
Incidence rates were highest among women with five or more live births (23/1,000 person-years [95% CI 20.3-26.7]) and lowest among women with one to two live births (11/1,000 person-years [9.6-12.5]). Adjustment indicated that much of the risk was due to sociodemographic factors and higher obesity, but after adjustment for all covariates, grandmultiparity (five or more) was still associated with a 27% increased risk for diabetes (hazard ratio 1.27 [95% CI 1.02-1.57]).
Grandmultiparity is predictive of future risk of diabetes after adjustment for confounders.
Diabetes Care 12/2006; 29(11):2349-54. · 8.09 Impact Factor
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ABSTRACT: To examine the relation between race and cesarean delivery, episiotomy, and low birth weight infants in pregnancies with type 2 and gestational diabetes mellitus and to identify factors that might explain racial differences.
Population-based, cross-sectional study of 1999-2004 Maryland hospital discharge data. Hospitalizations for delivery of pregnancies with type 2 and gestational diabetes mellitus were identified and matched to infants. The independent variable was maternal race. Dependent variables were cesarean delivery, episiotomy, and low infant birth weight. Stepwise logistic regression models were developed to estimate the independent effect of race on use of each procedure and infant birth weight, after adjusting for sociodemographic, hospital, and clinical factors.
We examined 6,310 deliveries for pregnancies with type 2 (15%) and gestational (85%) diabetes. Before adjustment, black race was associated with a higher odds of cesarean delivery (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.24-1.58) and low birth weight infants (OR 1.94, 95% CI 1.57-2.40) compared with white race. Adjustment for racial differences in preeclampsia and fetal heart rate abnormalities accounted for a modest degree of the racial variation in outcomes. With full adjustment, black race was still associated with a higher odds of cesarean delivery (OR 1.38, 95% CI 1.20-1.60) and low birth weight (OR 1.81, 95% CI 1.41-2.34) and a lower odds of episiotomy (OR 0.45, 95% CI 0.36-0.57).
In pregnancies with diabetes, adjustment for sociodemographic, hospital, and clinical factors only partially explains racial differences in procedure use and infant low birth weight.
Obstetrics and Gynecology 10/2006; 108(3 Pt 1):626-34. · 4.73 Impact Factor
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ABSTRACT: Estimates of the prevalence of postpartum thyroid dysfunction (PPTD) vary widely because of variations in study design, populations, and duration of screening. Our objective was to estimate the prevalence of PPTD among general and high-risk women, across geographical regions and in women with antithyroid peroxidase antibodies (TPOAbs). We conducted a systematic review and pooled analysis of the published literature (1975-2004), simultaneously accounting for sample size, study quality, percentage follow-up, and duration of screening. Data sources were MEDLINE and the bibliography of candidate studies. Two reviewers independently extracted data. Of 587 studies identified, 21 articles (8081 subjects) met the study criteria. The pooled prevalence of PPTD, defined as an abnormal thyroid-stimulating hormone (TSH) level, for the general population was 8.1% (95% confidence interval [CI] 6.6%-10.0%). The risk ratios for the development of PPTD among women with TPOAbs compared to women without TPOAbs ranged between 4 and 97 with a pooled risk ratio of 5.7 (95% CI: 5.3-6.1). Global prevalence varied from 4.4% in Asia to 5.7% in the United States. Prevalence among women with type 1 diabetes mellitus was 19.6% (95% CI 19.5%-19.7%). PPTD occurs in 1 of 12 women in the general population worldwide, 1 of 17 women in the United States and is 5.7 times more likely to occur in women with TPOAbs. The high prevalence may warrant routine screening TPOAbs, but the benefits, cost, and risks related to subsequent therapy must be weighed.
Thyroid 07/2006; 16(6):573-82. · 4.79 Impact Factor
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ABSTRACT: Depressive symptoms can be associated with lower health-related quality of life in late pregnancy. Few studies have quantified the effect of depressive symptoms in early pregnancy or among a racially and economically diverse group. Our goal was to estimate the independent association of depressive symptoms with health-related quality of life among a diverse group of women in early pregnancy.
We conducted a cross-sectional study of 175 pregnant women receiving prenatal care in a community and university-based setting. We related the presence of depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale score of 16 or more to health-related quality of life scores from the 8 Medical Outcomes Study Short Form domains: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. Quantile regression was used to measure the independent association of depressive symptoms with each of the 8 domains.
The study sample was 49% African American, 38% white, and 11% Asian. Mean (+/- standard deviation) gestational age was 14 +/- 6 weeks. The prevalence of depressive symptoms was 15%. Women with depressive symptoms had significantly lower health-related quality of life scores in all domains except Physical Functioning. After adjustment for sociodemographic, clinical, and social support factors, depressive symptoms were associated with health-related quality of life scores that were 30 points lower in Role-Physical, 19 points lower in Bodily Pain, 10 points lower in General Health, and 56 points lower in Role-Emotional.
Women in early pregnancy with depressive symptoms have poor health-related quality of life. Early identification and management of depressive symptoms in pregnant women may improve their sense of well-being.
II-2.
Obstetrics and Gynecology 05/2006; 107(4):798-806. · 4.73 Impact Factor
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Diabetes Care 07/2005; 28(6):1482-4. · 8.09 Impact Factor
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ABSTRACT: Our objective was to ascertain the priority of prenatal support services from the perspective of high-risk patients. The relationship between patients' needs, and both knowledge of and intent to use services, was examined, while documenting factors associated with the intent to use available support services.
The authors of this study conducted a cross-sectional survey of 102 African-American women at a university-affiliated, urban-health center. Patients' priority support needs were compared to their knowledge of and intent to use support services using chi-square statistics. Logistic regression was used to determine factors independently associated with patients' intent to use 5 support services (substance abuse counseling, community referrals, health education, nutrition services, and social work services), while adjusting for potential socioeconomic confounding variables, knowledge, and need for services.
Knowledge of existing services was independently associated with patient intent to use one or more support services (odds ratio 3.6; confidence interval 1.4-9.4). With each one-unit increase in parity, a 30% less odds (odds ratio 0.7; confidence interval 0.4-0.9) of using one or more support services occurred.
Physicians should ensure prenatal patients' knowledge of support services at healthcare centers. Multiparity is inversely related to women's intent to use support services, independent of their knowledge of service availability.
Ethnicity & disease 02/2004; 14(1):13-20. · 0.90 Impact Factor
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ABSTRACT: The purpose of this study was to examine, among the general public, the independent effect of race on women's use of health information resources.
A population-based random-digit dialing survey of adult women, aged 18 to 64 years, was conducted between October 1999 and January 2000. Subjects included 509 women (341 white women, 135 black women, and 33 women of other races). The response rate was 66%. The main outcome variable was the use of health information resources (print health or news media, broadcast media, computer resources [Internet], health organizations, organized health events). Logistic regression was used to determine the independent effect of race/ethnicity on the use of different information resources, with an adjustment for age, income, education, and marital status.
After the adjustment for socioeconomic factors, black women had <50% odds of using print news media (odds ratio, 0.5; 95% CI, 0.4-0.8), <60% odds of using computer-based resources (odds ratio, 0.4; 95% CI, 0.2-0.6), and <70% odds of using health policy organizations (odds ratio, 0.3; 95% CI, 0.2-0.7), compared with white women.
There is a large racial disparity in women's use of health information resources. Traditional sources that are used to provide patient information may not be effective in certain populations.
American Journal of Obstetrics and Gynecology 02/2003; 188(2):580-5. · 3.47 Impact Factor
