All ETDs from UAB

Advisory Committee Chair

Martha S Wingate

Advisory Committee Members

Janet M Bronstein

Eric W Ford

Allyson G Hall

Sara E Mazzoni

Document Type

Dissertation

Date of Award

2020

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Hypertensive disorders of pregnancy (HDP) are on the rise in the United States and contribute significantly to maternal and infant morbidity and mortality. The impact of such disorders is especially burdensome for women insured by Medicaid, for those who live in the South, and for those representing racial and ethnic minorities. It is evident across the aims of this dissertation that HDP remains an important public health concern to stakeholders in Alabama, its diagnosis is influenced by various maternal characteristics, and it can result in disparate severe outcomes for some populations. The first aim examines systems level decision-making in the context of a newly formed perinatal quality collaborative in Alabama to understand how public health decisions are made, particularly for the perinatal population, and how consensus is achieved when competing priorities exist. The second aim explores HDP diagnosis in the Alabama Medicaid population with a focus on the influence that maternal sociodemographic, clinical, and care characteristics have on its diagnosis. Finally, the third aim explores severe maternal morbidity (SMM) outcomes in the Alabama Medicaid population and investigates differences in SMM disparities by HDP diagnosis. Using diverse public health science methods, this work helps to inform a course of action to address concerns around HDP and their population-level and clinical outcomes.

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