Master's Culminating Experience
Objective: To evaluate the differences in prenatal maternal infections in women served by the City of Cincinnati health centers that have or have not had a preterm birth.
Methods: A retrospective and observational study of medical records of 738 patients seen at the City of Cincinnati health centers, who delivered in the years of 2005 and 2006. The usable data resulted in 668 total subjects. Data collected included types of health care visits prior to index pregnancy, if preconception/ reproductive health care was discussed, demographics, gestational age at first prenatal visit and at delivery, insurance at first prenatal visit and delivery, types of sexually transmitted diseases, and evaluation of periodontal disease.
Results: There was a significant difference in preterm births by race, resulting in the African American population with a higher percentage than the Hispanic and Caucasian populations (19.1% vs. 16.4% and 9.58%). There was also a significant difference between the Hispanic and African American population and the Hispanic and Caucasian population in regards to entry into prenatal care but no significant differences between preterm or term births. A significant difference was found in the type of insurance by race. Hispanic, Oriental/Asian, and Other populations had a higher percentage of being uninsured or self-pay at first prenatal visit and remained at a higher percentage at delivery of being uninsured or self-pay (p=< 0.0001). There was a significant difference between preterm birth and term births for gonorrhea (p= 0.0334). However, no significant differences existed between women with preterm and term births for other STI’s and multiple sexually transmitted infections. Periodontal disease was also not significant between women with preterm and term births.
Conclusions: The African American populations in the Cincinnati health centers appear to be at greater risk for preterm births than the other populations served. A large portion of the health center population is without insurance at first prenatal visit but is able to obtain coverage by time of delivery, though there is a significant difference in obtaining health insurance for the Hispanic, Oriental/Asian, and Other populations. These results may be due to populations that are unable to provide appropriate documentation to achieve insurance coverage such as Medicaid. Gonorrhea and multiple sexually transmitted infections appear in a higher percentage of preterm births. This would indicate an untreated population and a need for interventions and education. Although periodontal disease did not result in a significant difference in preterm births, the low subject number would suggest a need for a change in prenatal evaluation and documentation of dental status as well as follow up on referrals to dental care.
Singhoffer, E. (2008). Preterm Birth Rates in Pregnant Women with Sexually Transmitted Infections: Cincinnati Public Health Centers 2005 and 2006 Deliveries. Wright State University, Dayton, Ohio.