Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy


Comparative and Experimental Medicine

Major Professor

Agricola Odoi

Committee Members

Kathleen Brown, Samantha Ehrlich, Carole Myers


Preterm birth, newborn screening refusal, and postpartum depression represent three emerging areas of concern that have not been previously investigated in North Dakota. Their potential impact creates significant social, behavioral, and economic burdens. Although various studies have investigated preterm birth and postpartum depression, to the best of my knowledge, newborn screening refusal in the United States has not been previously investigated. In alignment with the role of Title V of the Social Security Act (Maternal and Child Health) Programs to conduct ongoing statewide needs assessments, the objectives of this study was to investigate and identify predictors of preterm birth, newborn screening refusal and postpartum depression.

The study used data from the North Dakota (ND) Pregnancy Risk Assessment Monitoring System, the ND Newborn Screening Program, and the ND Division of Vital Records. Factor-specific prevalence and confidence intervals of potential predictors were computed. Logistic regression models were used to investigate and identify predictors of preterm birth and postpartum depression. Since newborn screening refusal is a rare outcome, multivariable Firth logistic regression was used to investigate maternal and provider predictors of newborn screening refusal. Adjusted odds ratios (AOR) and their 95% confidence intervals were computed for all identified significant predictors of preterm birth, newborn screening refusal, and postpartum depression. Goodness-of-fit of the models were evaluated using the Hosmer-Lemeshow tests.

The identified significant (p < 0.05) predictors of preterm birth (maternal hypertension, premature rupture of membranes, prior preterm birth, rural residence, multiple gestation, maternal age ≥ 35, multiple gestation and < 9 prenatal care visits); newborn screening refusal (homebirths, non-credentialed birth attendants, refusal of Hepatitis B vaccine, and fewer prenatal care visits); and postpartum depression (unintended pregnancies, high childhood adversity, American Indian race, and history of depression), offer useful insight into the epidemiology of these emerging issues in North Dakota.

Ongoing evaluation and the implementation of health programs and policies that allow women to plan pregnancies, access preconception care and prenatal care, and access to behavioral health services prior to, during, and after pregnancy will remain invaluable in mitigating these three emerging issues, thereby aiding in reducing their burden.

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