Trends in Early Prenatal Care Among Women with Pre-Existing Diabetes: Have Income Disparities Changed?

Abstract

Background: Women with pre-existing diabetes are at high maternal risk for comorbidities and death, particularly when early prenatal care is not received. Low income is a known barrier to early prenatal care. It is unknown whether recent policies to expand access to prenatal care have reduced income disparities. We hypothesized that income disparities would be minimized and that the odds of receipt of first trimester prenatal care among women with pre-existing diabetes would become similar across income strata over time.

Material and methods: Using the Colorado birth certificate registry from 2007 to 2014, receipt of prenatal care was assessed retrospectively in 2,497 women with pre-existing diabetes. Logistic regression was used to examine the association between high (>$50,000), medium ($25,000-50,000), and low (<$25,000) income strata and receipt of first trimester prenatal care by birth year, adjusted for demographics.

Results: High, medium, and low income represented 29.5%, 19.0%, and 51.5% of the cohort, respectively. Women with high income were more likely to receive first trimester care than women with low income from 2007 [adjusted odds ratio, 95% confidence interval: 2.16 (1.18, 3.96)] through 2013 [1.66 (1.01, 2.73)], but significant differences were no longer observed in 2014 [1.59 (0.89, 2.84)]. The likelihood of receiving first trimester prenatal care was not significantly different between medium- and low-income strata from 2007 [1.07 (0.66, 1.74)] through 2014 [0.77 (0.48, 1.23)].

Conclusions: From 2007 to 2013, women in Colorado with diabetes were more likely to receive early prenatal care if they were in the highest income stratum than in the lowest stratum. In 2014, receipt of first trimester care became equitable across all income strata. Future work should examine national patterns of income with receipt of prenatal care and outcomes among women with pre-existing diabetes.

Keywords: policy; pregnancy; socioeconomic status.

FIG. 1.

Flowchart of mothers with pre-existing diabetes included in the Retrospective Cohort Study from Colorado birth certificate data during 2007–2014.

FIG. 2.

Trends in receipt of first trimester prenatal care among women with high versus low annual household income. The solid black line represents the OR of receipt of first trimester prenatal care for women with high versus low annual household income. The gray shade represents the 95% CI band. CI, confidence interval; OR, odds ratio.

FIG. 3.

Trends in receipt of first trimester prenatal care among women with medium versus low annual household income. The solid black line represents the OR of receipt of first trimester prenatal care for women with medium versus low annual household income. The gray shade represents the 95% CI band.