Date of Award

Fall 12-2018

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

ANNA V. WILKINSON, PHD

Second Advisor

H. SHELTON BROWN, PHD

Third Advisor

ADRIANA PEREZ, PHD

Abstract

Inadequate and excess gestational weight gain (GWG) are serious, but potentially preventable adverse pregnancy outcomes which affect as many as two-thirds of pregnant women in the United States. While location and space are associated with a variety of pregnancy outcomes, limited research has investigated potential spatial variation in GWG. The goal of this research is to improve the knowledge of how spatial geography is associated with GWG through secondary analyses of 70,000 to 160,000 birth certificate registry records for Texas mothers with a live birth delivery in 2014. Specifically, this research attempts to assess whether access to obstetrics and gynecologist (OBGYN) providers and country of birth among Hispanic women were associated with gestational weight gain. Overall, this research indicates that space is important in understanding GWG, though the significance of space depends on the studied risk factor. Analyses of women in the Houston-The Woodlands-Sugarland Metropolitan Statistical Area revealed that potential geographic access to OBGYN providers was not associated with inadequate or excess GWG; although, there was variation in the odds of inadequate or excess GWG in the area. Additionally, analyses of Hispanic women demonstrated statistically significant variation in the association between maternal county of birth and total GWG. Patterns indicated that foreign-born maternal birth compared to maternal birth in the United States is associated with increased total GWG along the Texas-Mexico border and in rural areas in Texas with a shift to less GWG along the Texas I-35 corridor and in northwest Texas. Consistent across the research was the importance of the association between prepregnancy weight and GWG. While space is important to understanding GWG, this research reveals that prepregnancy weight may be the key factor in controlling GWG. Few studies explore spatial variation in GWG and this was the first to explore variation within Texas which could show variation in studied maternal characteristics across the entire state. Public health researchers may utilize methods from this research as a template for incorporating spatial components into their research as space may improve the modelling process and elucidate the role of studied health characteristics, investigate the possibility of a threshold effect for geographic access to care, and explore the role of spatial variation in the Hispanic Paradox.

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