Differences in folic acid use, prenatal care, smoking, and drinking in early pregnancy by occupation
Highlights
► We evaluated four common periconceptional behaviors by maternal occupation. ► Several occupations had higher prevalences of these risk behaviors. ► Our findings could guide workplace interventions to promote perinatal health.
Introduction
Some of the most common, modifiable, and relatively strong risk factors for adverse pregnancy outcomes are lack of periconceptional folic acid supplementation, lack of early prenatal care, smoking, and alcohol use (Banakar et al., 2009, Ip et al., 2010, Salmasi et al., 2010, Vintzileos et al., 2002, Werler et al., 1999). Despite medical recommendations and educational programs, a substantial proportion of pregnant women engage in each of these behaviors (Bailey and Sokol, 2008, Centers for Disease Control and Prevention, 1992, U.S. Preventive Services Task Force, 2009, Vintzileos et al., 2002). Hence, additional efforts to reduce these behaviors are warranted.
While it is known that several of these behaviors vary by occupation in the general population (Cano-Serral et al., 2006, Milham and Davis, 1991, Salvador et al., 2007) they have not been assessed among pregnant workers. The identification of maternal occupational groups that are associated with high rates of high-risk behaviors could provide target groups for focused educational campaigns. Such targeted strategies would be warranted even if occupation is indirectly related to these behaviors through the characteristics of women (e.g. educational level, age) who enter particular occupations, since occupation may be easier to target than would the underlying maternal characteristic.
The direct and indirect costs of maternal and child healthcare are great, and to contain rising employee health insurance costs, considerable effort is being put forward to prioritize, develop, and implement workplace health promotion activities (Campbell, 2007, Chapman, 2005). We conducted these analyses to identify differences in maternal folic acid supplementation, early prenatal care, smoking, and mild to moderate drinking during early pregnancy by maternal occupational group in a population-based study. Identifying occupational groups with high rates of high-risk behaviors could be useful in deciding where an investment in health promotion activities (e.g., workplace education or interventions) aimed at reducing high risk behaviors among women of reproductive age could improve reproductive outcomes and reduce healthcare costs.
Section snippets
Study sample
We used data from the mothers of infants with due dates between October 1, 1997 and December 31, 2007 in the National Birth Defects Prevention Study (NBDPS), a large population-based case–control study. Only mothers of non-malformed control infants were included in these analyses, as they are more likely than mothers of cases to represent the distribution of behaviors in the general population and including case mothers would select for women that were more likely to participate in these
Results
Among 8494 interviewed NBDPS control mothers, 5153 women employed between B1 and P3 were included in our analyses (Table 1). The majority of these women (87.7%) were employed in only one job during this period. The most common major occupational groups were office/administrative support (21.6%); sales and related (11.4%); education/training/library (9.4%); healthcare practitioners/technical (8.4%); management (7.7%); and food preparation/serving-related (7.6%) occupations. Three occupational
Discussion
Using data from a large, population-based study, we identified several occupational groups in which women were less likely to use folic acid or have prenatal care, and were more likely to engage in smoking or moderate to heavy drinking during early pregnancy. Occupations in which women were more likely to engage in one or more of the four high-risk behaviors included: healthcare support, protective service, food preparation/serving-related, building and grounds cleaning/maintenance, sales and
Conflict of interest statement
The authors declare that there is no conflict of interest.
The following are the supplementary data related to this article.
Acknowledgments
This project was partially supported by the Texas Center for Birth Defects Research and Prevention, under cooperative agreement U01DD000494 from the Centers for Disease Control and Prevention with the Texas Department of State Health Services. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
References (23)
- et al.
Socioeconomic inequalities in the provision and uptake of prenatal care
Gac. Sanit.
(2006) - et al.
Smoking and sedentary behavior as related to work organization
Soc. Sci. Med.
(1991) - et al.
Trends in social inequalities in pregnancy care in Barcelona (Spain), 1994–97 versus 2000–03
Gac. Sanit.
(2007) - et al.
The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions
Am. J. Obstet. Gynecol.
(2002) - et al.
Pregnancy and alcohol use: evidence and recommendations for prenatal care
Clin. Obstet. Gynecol.
(2008) - et al.
Fetal alcohol spectrum disorder (FASD)
Indian J. Pediatr.
(2009) Investing in maternal and child health: an employer's toolkit
Center for Prevention and Health Services, National Business Group on Health, Washington, DC
(2007)Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects
MMWR Morb. Mortal. Wkly Rep.
(1992)Meta-evaluation of worksite health promotion economic return studies: 2005 update
Am. J. Health Promot.
(2005)- et al.
Control selection and participation in an ongoing, population-based, case–control study of birth defects: the National Birth Defects Prevention Study
Am. J. Epidemiol.
(2009)
Work-related determinants of health behavior
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2022, Preventive MedicineCitation Excerpt :Lack of, and delayed, entry into prenatal care has been associated with younger age (Goldenberg et al., 1992), higher parity (Beeckman et al., 2011), not having a regular medical provider (Braveman et al., 2000), being of non-white race/ethnicity (Goldenberg et al., 1992; Bryant et al., 2010; Greenberg, 1983; Taffel, 1978), and having lower educational attainment (Ayoola et al., 2010; Ward et al., 2013). Lack of transportation, lack of childcare, type of employment, or insurance eligibility have also been associated with not obtaining prenatal care (Goldenberg et al., 1992; Joyce et al., 1983; Agopian et al., 2012; Bengiamin et al., 2010). Many of these social and economic factors are also associated with access to healthcare and the development of chronic health conditions (Wang et al., 2020; Admon et al., 2017; Christopher et al., 2016).
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