Adverse Birth Outcomes and Associated Risk Factors
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The cause for adverse birth outcomes such as prematurity, low birth weight, small for gestational age, among others, is not clearly understood. Despite medical advancements, infants that overcome poor birth outcomes face significant cognitive, behavioral, and developmental challenges in their childhood and throughout their lifespan. It has been established that some race/ethnic groups and populations in the lower economic strata are disproportionately affected by adverse birth outcomes. It is of utmost importance to continue exploring factors that contribute to race/ethnic disparities in order to develop targeted intervention strategies. In Nevada, several initiatives have been developed to address disparities in poor birth outcomes, however, the state faces challenges such as: provider shortages, long distance to hospitals and/or areas that offer health care services, low high school graduation rates, exposure to environmental tobacco smoke among casino workers, a growing prescription and illicit drug use problem, among others. The goals of this epidemiological study were to: 1) determine whether distance was a barrier in obtaining specialized care for very low birth weight (VLBW) infants, 2) asses the association between working I n the service industry and preterm birth among Hispanic women and 3) evaluate the relationship between depression, substance use, and low birth weight.In study one, distance of more than 50 miles was found to be associated with delivery of a VLBW infant in a non-level III hospital. Study two revealed that Hispanic women working in the service industry had increased odds of preterm birth compared to those working in administrative support positions. Results of study three showed that mothers who used prescription drugs during pregnancy had higher odds of delivering a low birth weight baby. Additionally, women with a clinical diagnoses of depression prior to becoming pregnant had higher odds of using substances during pregnancy (OR: 3.51; 95% CI = 3.46–3.56) compared to women who did not have a clinical diagnoses of depression prior to pregnancy. The findings of this dissertation support avenues to further explore factors associated with adverse birth outcomes and barriers to accessing health care services among pregnant women.