Jennifer Haas, MD, MSPH¹, Rebecca Jackson, MD², Mitzi Dean, MHA³, Anita L. Stewart, PhD⁴, Phyllis Brawarsky, MPH⁵, Gabriel J. Escobar, MD⁶, and Elena Fuentes-Afflick, MD³. (1) General Medicine, Brigham and Women's Hospital/ Harvard Medical School, 1620 Tremont St, Boston, MA 02458, 617-525-6652, jhaas@partners.org, (2) Women's Health Clinic, San Francisco General Hospital, San Francisco Public Health Deparment, San Francisco General Hospital, 1001 Potrero Avenue, 5M, San Francisco, CA 94110, (3) University of California, San Francisco, Box 0936, San Francisco, CA 94143, (4) Institute for Health & Aging, University of California San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, (5) Bureau of Health Statistics, Research and Evaluation, Massachusetts Department of Public Health, 250 Washington Street, 6th floor, Boston, MA 02108, (6) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612

Despite extensive evaluation, our understanding of the etiology of premature, low birth weight births is incomplete, and therefore interventions have had limited success. A broader perspective on a woman’s health prior to pregnancy may be necessary to further understand the causes of adverse perinatal outcomes. The goal of this study was to examine the relationship between a woman’s pre-pregnancy health and the risk of a subsequent low birth weight or preterm birth in a longitudinal cohort of 1,619 women who delivered a singleton infant. Each woman completed up to 3 telephone surveys, and the charts of the women and infants were reviewed. During each interview, women were asked to report their health status using standardized instruments, as well as a variety of other demographic, medical, and obstetrical factors. Self-reported physical function for the month prior to pregnancy was significantly associated with having a subsequent premature or low birth weight infant (odds ratio 2.02; 95% confidence interval 1.26-3.24), after adjustment for traditional prenatal risk factors. Examination of the relative contributions of demographic, pre-pregnancy, and pregnancy factors revealed that demographic characteristics alone explained only 15.5% of the variation in risk of adverse birth outcome, whereas pre-pregnancy characteristics explained 42.2%, and risk factors that occurred during pregnancy contributed 42.3%. In this cohort, a woman’s pre-pregnancy health status was as important as traditional risk factors for adverse birth outcome that occurred during pregnancy. These findings offer a broader perspective on risk factors for adverse birth outcome than studies that have focused solely on risk factors that occur during the prenatal period.

Learning Objectives:

• A participant in this session will gain an understanding of pre-pregnancy maternal health status as a risk factor for premature and low birth weight infants.

Keywords: Birth Outcomes, Maternal Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.