Preconception health status and associated disparities among rural, Midwestern women in the United States

• Published in: Birth (Berkeley, Calif.) Vol. 50; no. 1; pp. 127 - 137
• Main Authors: DiPietro Mager, Natalie A., Zollinger, Terrell W., Turman, Jack E., Zhang, Jianjun, Dixon, Brian E.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2023
• Subjects: Acids; Adolescent; Adult; Alcohol use; At risk populations; Birth control; Cross-Sectional Studies; Demography; Diabetes; Female; Folic Acid; Health behavior; Health disparities; health risk behaviors; Health risks; Health Status; Humans; Hypertension; Infants; Maternal characteristics; Middle Aged; Ohio; Physical activity; preconception and interconception health; Preconception Care; Pregnancy; Risk Assessment; Risk behavior; Risk factors; Rural communities; rural health; Smoking; Surveillance systems; Tracking; Underserved populations; United States; Vitamin B; Women; women's health; Womens health; Young Adult; United States; Ohio; United States > US; risk factors; health disparities; women's health; rural health; cross-sectional studies; health risk behaviors; preconception and interconception health
• ISSN: 0730-7659; 1523-536X
• DOI: 10.1111/birt.12706

Background
Little is known about the preconception/interconception health and behaviors of reproductive‐age women in the rural Midwest of the United States. The purpose of this study was to quantify preconception/interconception health status and to identify disparities compared with statewide estimates.
Methods
In this cross‐sectional study, we collected data on 12 health conditions and behaviors that are risk factors for adverse maternal and infant health outcomes from nonpregnant women ages 18‐45 years in rural northwestern Ohio. Statistical tests were used to identify associations between selected demographic characteristics and a subset of eight high‐priority health measures (smoking, diabetes, heavy alcohol use, folic acid intake, normal weight, sufficient physical activity, and effective contraception use); all but physical activity could be compared with Ohio estimates derived from the Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey.
Results
Three hundred‐fifteen women participated, with 98.4% reporting at least one high‐priority risk factor. Statistically significant differences were identified among subpopulations related to smoking, folic acid, normal weight, sufficient physical activity, and effective contraception use. In addition, the proportion of participants reporting hypertension (P < 0.001), smoking (P < 0.001), abnormal weight (P = 0.002), and lack of daily folic acid intake (P = 0.006) were statistically significantly higher than expected based on statewide estimates.
Conclusions
Women in the rural Midwest of the United States are at risk for poor health and pregnancy outcomes. Statewide estimates tracking preconception/interconception health status may obscure variation for at‐risk groups, particularly in rural or underserved areas. These findings illustrate the need for interventions to advance preconception/interconception health and improve methods to capture and analyze data for rural women.