THE DETERMINATION OF FACTORS THAT AFFECT PRE AND

POSTPARTUM CARE CHOICES IN AFRICAN AMERICAN

PREGNANT WOMEN IN URBAN COMMUNITIES
PRESENTED BY SIMONE GABRIEL

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Introduction
 Chronic health conditions affect over 27% of pregnant women 4

 African American women (AAW) are at the highest risk for Severe Maternal Morbidity (SMM) 5 (Harp
 Increase in postpartum Emergency Department (ED) use among women 7       
 Preexisting comorbidities [23]

 Pregnancy related comorbidities

 1 in 4 ED visits aren’t clinical emergencies 8, 9

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Review of Literature
 Perak, A. (2021). Associations of gestational cardiovascular health with pregnancy outcomes: the Hyperglycemia and Adverse Pregnancy Outcome study. American Journal
of Obstetrics and Gynecology, 224(2), 210.e1–210.e17. https://doi.org/10.1016/j.ajog.2020.07.053

 Major Findings
 More favorable CVH score associated with lower risks of adverse pregnancy outcomes
 Having ≥1 intermediate metrics associated with adverse outcomes
 Limitations
 Excluded women with pregestational diabetes and preterm births
 CVH was measured at a single point and late in gestation

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Review of Literature
 Howell, E. A., Balbierz, A., Beane, S., Kumar, R., Wang, T., Fei, K., … Pagán, J. A. (2020). Timely Postpartum Visits for Low-Income Women: A Health System and
Medicaid Payer Partnership. American Journal of Public Health, 110(S2), S215–S218. https://doi.org/10.2105/ajph.2020.305689

 Major Findings
 Educational intervention benefitted participants
 Program participants had higher rates of postpartum visits
 Limitations
 Did not assess demographics other than income status

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Review of Literature
• Cunningham, S. D., Magriples, U., Thomas, J. L., Kozhimannil, K. B., Herrera, C., Barrette, E., … Ickovics, J. R. (2017). Association Between Maternal Comorbidities and
Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women. Academic Emergency Medicine, 24(8), 940–947.
https://doi.org/10.1111/acem.13215‌

 Major Findings  Gestational age of pregnancies

 20% women had ≥1 ED visits

 29% women had ≥2 ED visits
 Significant increase in probability of ED use
 Limitations
 Did not assess: [28]

 Demographic data of participants

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Gap in Research
 Unknown why AAW are going to the ED for pre/postpartum care rather than a primary care provider
 AAW have higher rates of high-risk pregnancies
 Aren’t getting level of care needed

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Goal
 Determine factors that affect pre and postpartum care choices in African American pregnant women in urban communities.

Hypotheses
 AAW are going to the ED for pre/post natal care as a result of
 Lack in pre/post natal educational intervention 6

? ?
 Mistrust of the health care system 13, 14, 20  

 Proximity to hospital 6
? ? ? ?
 Financial situation 6,13

? vs. ? ?
?
 Comorbidity risks10, 7

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Variables
 Independent
 Level of educational intervention
 Dependent
 Level of trust in healthcare system
 Choice in prenatal care
 Hospital proximity
 Control:
 Financial situation
 ED location
 Comorbidity risk

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

1  Acquire participants from mentor’s urban hospital

Participants
 Women
 Ages 18 and older
 Speaks English/Spanish
 Currently pregnant
 Live singleton birth within 8 weeks of visit

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

2  Survey
 Health related causes

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

3  Survey
 Demographics

RACE
AND
ETHNICIT
Y

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

4  Survey
 Educational intervention

U.S. Department of Health and Human Services, National Institutes of Health,

National Library of Medicine. “Health Literacy Tool Shed.” Bu.edu, 2012,

[39] healthliteracy.bu.edu/s-tofhla. Accessed 25 May 2021.

 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

5  Survey
 Personal hesitations

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Data Analysis
 Store on Microsoft Excel
 Statistical analysis
 X2
 Krusskal-Wallis

 Analysis results
 Correlation between
 Comorbidity risk/level of trust in healthcare system
 ED visits
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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Expected Findings
 AAW visit the ED as a result of
 Comorbidity risk
 Mistrust of the health care system

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

 Limitations
 Misunderstanding of questions
 Self-reporting

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Application
 Decrease PRMR in African American pregnancies
 Freeing up ED
 Clarify why patients would go to the ED instead of primary care provider
 can better healthcare system overall

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 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Gap in Research Expected Findings

 Unknown why AAW are going to the ED for pre/post  AAW visit the ED as a result of
natal care rather than a primary care provider
 Comorbidity risk

Goals  Mistrust of the health care system

 Determine why AAW are using the ED as opposed to

visiting a primary care physician
Application
 Work to decrease mortality rate in African American
Methods pregnancies
 Survey pregnant women in ED
 Review of Gap, Goal, Results and Future
Introduction Methods Application Conclusion
Literature Hypothesis Discussion Focus

Future Focus
 Research the general disparity in healthcare overall
 Are African American patients with conditions getting the
information they need?
 How much are studies like the Tuskegee Study impacting
African American’s perception of the public healthcare system?

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ANY QUESTIONS?
THE DETERMINATION OF FACTORS THAT AFFECT PRE AND POSTNATAL CARE
CHOICES IN AFRICAN AMERICAN PREGNANT WOMEN IN URBAN COMMUNITIES
PRESENTED BY SIMONE GABRIEL

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