Elsevier

Preventive Medicine

Volume 55, Issue 4, October 2012, Pages 341-345
Preventive Medicine

Differences in folic acid use, prenatal care, smoking, and drinking in early pregnancy by occupation

https://doi.org/10.1016/j.ypmed.2012.07.015Get rights and content

Abstract

Objective

To describe differences in four high risk periconceptional behaviors (lack of folic acid supplementation, lack of early prenatal care, smoking, and drinking) by maternal occupation.

Methods

Analyses were conducted among women in the National Birth Defects Prevention Study who delivered liveborn infants without birth defects. Periconceptional occupational data were collected using a computer-assisted telephone interview and occupational coding was performed using the 2000 Standard Occupational Classification System. Logistic regression analyses were conducted to determine whether prevalence of behaviors differed between occupational groups.

Results

Subjects included 5153 women employed during early pregnancy from 1997 to 2007. Compared to women in management, business, science, and arts occupations, women in other occupations (e.g., service occupations) were significantly more likely to engage in all four high risk behaviors. Specifically, women in food preparation/serving-related occupations were significantly more likely to engage in all four behaviors compared to women in all other occupational groups (odds ratios: 1.8–3.0), while women in education/training/library occupations were significantly less likely to do so (odds ratios: 0.2–0.5).

Conclusion

We identified several occupational groups with an increased prevalence of high-risk maternal behaviors during pregnancy. Our findings could aid in developing interventions targeted towards women in these occupational groups.

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.

. Unadjusted odds ratios and 95% confidence intervals for the association between Education, Training, and Library and Food Preparation and Serving-related occupational subgroups and behaviors during B1–P3a, National Birth Defects Prevention Study, 1997–2007b.

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.

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