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PubMed1995

Pregnant teenagers' reasons for seeking or delaying prenatal care.

The purpose of this descriptive study was to explore the reasons that pregnant teenagers do or do not seek prenatal care during the first trimester of pregnancy. Interviews were conducted with a volunteer sample of 49 pregnant adolescent girls, 13 to 18 years old, in primary care settings. The informants' self-reported reasons for seeking early prenatal care included feeling ill, being worried about themselves, wanting a pregnancy test, and the teen's mother insisting that she begin prenatal care. Reasons for delaying care included not recognizing pregnancy symptoms, denying being pregnant, fear of parents' response to the pregnancy, and lack of financial resources. The findings suggest that pregnant adolescents who sought early prenatal care had adequate family support and a stronger knowledge base about pregnancy than those who delayed care. Nurses and other health care personnel in clinical practice should provide information about the symptoms and signs of pregnancy and about the importance of initiating early prenatal care, in all encounters with preadolescent and adolescent girls and their mothers, to increase the likelihood that teens will seek early prenatal care if they become pregnant.

Adolescent↗
PubMed1993

[Using prenatal care in the Tunisian context: barriers and motivation factors].

Several barriers to and motivators of antenatal care are analysed in the context of a developing country. The authors found that socio-cultural factors are as important as organizational factors in motivating women to seek antenatal care. While social and economic development may improve the quality of life in the long term, it is important to respond now to the needs of pregnant women in order to encourage them to use such services. A comprehensive analysis of certain organizational factors would be useful in achieving this goal.

Adolescent↗
PubMed2000

HIV-1 infected women and prenatal care utilization: barriers and facilitators.

In an effort to understand issues affecting prenatal care access and utilization from the perspectives of human immunodeficiency virus (HIV)-infected women who receive inadequate prenatal care, we conducted three in-depth qualitative and quantitative interviews. From a thematic analysis of the narrative interviews, four broad areas emerged as pertinent to these women's prenatal care experiences. These were issues related to pregnancy, HIV, psychosocial conditions, and the health care system. For these women, the barriers to prenatal care utilization included the unexpected and unplanned nature of the pregnancy and mental health issues related to HIV infection. Poverty, periodic homelessness, addiction to illicit substances, and lack of social support were also important barriers. Furthermore, perceptions of the health care system as threatening, including fears related to consequences of disclosing illicit activities, discrimination, and breach of confidentiality emerged as salient barriers. Facilitating factors included the pregnancy being experienced as a life-transforming event, concern for their children, especially preventing HIV-1 vertical transmission, availability of treatment, and support from health care professionals. Prominent throughout the interviews were the women's mental health concerns and need for professional support.

Adult↗
PubMed1991

Prenatal care: a path (not taken) to improved perinatal outcome.

Six hundred and six low income women were studied postpartum to assess the relationship among medical risk factors, use of alcohol and drugs, race, content/amount of prenatal care and birth weight. Content of prenatal care was defined by the number of medical procedures performed and amount of care was determined by the Kessner Index. Women received prenatal care in 1-4 different sites. Those remaining in or transferring to sites performing the least number of routine prenatal procedures delivered babies with lower birth weights than those selecting sites performing more procedures. A path analysis (LISREL) constructed a priori to model the relationships among medical risk factors, use of alcohol and drugs, race, content/amount of prenatal care received and birth weight, revealed that women at high medical risk were more likely to receive care at sites offering more medical procedures while those who abused drugs and alcohol were significantly less likely to receive such care. Medical risk factors and the use of alcohol and drugs had significant negative effects on birth weight, while content and amount of prenatal care contributed to improved birth weight. These findings are discussed relative to issues of access to high quality prenatal care by patients at greatest risk and to the prevention of low birth weight infants.

Adolescent↗
PubMed2003

Preventing low birth weight: is prenatal care the answer?

OBJECTIVES: To review the evidence of effectiveness of prenatal care for preventing low birth weight (LBW). METHODS: We reviewed original research, systematic reviews, meta-analyses and commentaries for evidence of effectiveness of the three core components of prenatal care--risk assessment, health promotion and medical and psychosocial interventions--for preventing the two constituents of LBW: preterm birth and intrauterine growth restriction (IUGR). RESULTS: Clinical risk assessment will fail to identify the majority of pregnancies at risk for preterm delivery or IUGR. While biophysical and biochemical modalities appear promising, their cost-effectiveness has not been demonstrated, nor can their routine use be recommended in the absence of effective interventions. Smoking cessation programs appear to be modestly effective. There is insufficient evidence to conclude a benefit for nutrition interventions, work counseling or preterm birth education. Only antenatal corticosteroid therapy has demonstrated a clear benefit in the tertiary prevention of preterm delivery. Interventions for which there is insufficient evidence to conclude a benefit include bed rest, hydration, sedation, cerclage, progesterone supplementation, antibiotic treatment, tocolysis without concomitant use of corticosteroids, thyrotropin-releasing hormone, psychosocial support and home visitation. Additionally, there is a paucity of evidence supporting the effectiveness of prenatal interventions, such as low-dose aspirin, bed rest, maternal hyperoxygenation, plasma volume expansion and antenatal fetal assessment, in preventing IUGR or its associated morbidity and mortality. CONCLUSIONS: Neither preterm birth nor IUGR can be effectively prevented by prenatal care in its present form. Preventing LBW will require reconceptualization of prenatal care as part of a longitudinally and contextually integrated strategy to promote optimal development of women's reproductive health not only during pregnancy, but over the life course.

Female↗
PubMed1996

Prenatal care and birth outcomes of a cohort of HIV-infected women.

Adequate prenatal care has been linked to improved birth outcomes in general populations but has not been assessed in HIV-infected women. We examined longitudinal claims files and vital statistics records for women in the New York State Medicaid HIV/AIDS data base delivering a singleton from 1985 through 1990. Adequacy of the self-reported number of prenatal visits was assessed by the Kessner index. In logistics models, we estimated the association of prenatal care, illicit drug use, and other maternal characteristics with three outcomes; low birth weight, preterm birth, and small-for-gestational-age. Of 2,254 singletons delivered by this HIV-infected cohort, 28% were low birth weight, 23% were preterm birth, and 20% were small for gestational age. Two-thirds had inadequate prenatal care. Non-drug users had 57 and 26% lower adjusted odds of low birth weight and preterm delivery than drug users. The adjusted odds of low birth weight and preterm birth for women with an adequate number of prenatal visits were, respectively, 48 and 21% lower than for women with inadequate care. Adequate prenatal care was also associated with a 43% reduction in the odds of small-for-gestational-age. An adequate number of prenatal visits by women in this HIV cohort was associated with a significant reduction in all three adverse birth outcomes, but most had inadequate prenatal care. These data support strengthening efforts to bring pregnant, HIV-infected women into care.

Adult↗
PubMed2003

The unrealized potential of prenatal care. A population health approach.

To review the scientific evidence behind the traditional view that prenatal care improves pregnancy outcomes. The literature published in English between 1965 and 2002 was searched for relevant studies and opinions on prenatal care outcomes. As search engine we used the MEDLINE bibliographic database, employing a combination of keywords, including pregnancy, prenatal care and outcomes. Editorials, proceedings of meetings and reviews, were included in the analysis. This review was not intended to be a systematic or exhaustive review of the literature on prenatal care. The significant heterogeneity of the retrieved papers made any aggregation impossible. In each of the reviewed studies we assessed the methodologic aspects and validity of conclusions, using established criteria for the evaluation of prenatal interventions. Our processing of editorials and other personal opinions was conducted with the intention to draw the line between statements based on scientific evidence and speculative, emotional or traditional concepts. Outcomes research related to prenatal care is marred by methodologic flaws and conceptual problems. While traditional prenatal protocols are based on an individual-centered medical care system, the outcomes are measured using population-based parameters. Interventions capable of improving maternal and neonatal outcomes at the population level are more likely to be social and economic rather than health interventions case by case.

Community Health Planning↗
PubMed1993

[Analysis of prenatal care in adolescents who delivered in the obstetric clinic IPG PAM in Szczecin in the years 1990-1992].

The analysis of prenatal care was taken of 67 adolescent's who delivered in Obstetric Clinic IPG PAM in Szczecin, during the period 1990-1992. The quantitative dimension of prenatal care was evaluated by means of Kessner's Index at all, adapted by Buschner at all. The week of gestation that prenatal care began and number of prenatal visits were analysed. It was stated that adequate prenatal care received only 6% pregnant adolescents, inadequate 13.4%, intermediate 64% while 16.4% adolescents received no prenatal care. Earliest delivery and lowest infant birth weight were associated with no prenatal care. The significant correlation relationships between the week of the first visit, numbers of prenatal visits neonatal birth weight were no existed.

Adolescent↗
PubMed1989

Cocaine abuse during pregnancy: correlation between prenatal care and perinatal outcome.

Cocaine abuse during pregnancy has been associated with increased perinatal morbidity and mortality regardless of the quantity or quality of prenatal care. In this study, we tested the hypothesis that among cocaine-abusing women delivering at the same institution, those receiving comprehensive prenatal care have better perinatal outcome than those receiving little or no prenatal care. Between January 1, 1984 and July 1, 1987, 120 pregnant women who abused cocaine received multidisciplinary prenatal care in the Perinatal Center for Chemical Dependence of Northwestern University (group 1). During this same period, we identified 21 cocaine-abusing parturients at our institution who were not enrolled in the Perinatal Center for Chemical Dependence and who received little or no prenatal care (group 2). Control subjects were selected from the general obstetric population for comparison. Data from these two groups were compared with each other and with matched control pregnancies. Group 2 pregnancies had lower mean gestational age at delivery, lower mean birth weight, and a higher incidence of preterm delivery than group 1 pregnancies. Furthermore, groups 1 and 2 were significantly different from control pregnancies for these parameters. We conclude that comprehensive prenatal care may improve outcome in pregnancies complicated by cocaine abuse; however, the perinatal morbidity associated with cocaine abuse cannot be eliminated solely by improved prenatal care.

Adult↗
PubMed2003

The impact of prenatal care on preterm births among twin gestations in the United States, 1989-2000.

OBJECTIVE: The purpose of this study was to determine the association between prenatal care and preterm births among twin gestations in the presence and absence of high-risk pregnancy conditions. STUDY DESIGN: Twin birth data in the United States were used to determine the association between preterm birth and prenatal care with the use of logistic regression. RESULTS: Of the 779,387 twin births, 54.7% twin births were delivered preterm. The rate was higher among black women than among white women in the presence (57.0% vs 51.2%, respectively) and absence (70.3% vs 61.6%, respectively) of prenatal care. The absence of prenatal care increased the relative risk for preterm birth by 1.24-fold among black women and by 1.22-fold among white women. Lack of prenatal care was associated with increased preterm birth rates in the presence of most high-risk conditions. CONCLUSION: Prenatal care is associated with fewer twin preterm births in the presence and absence of high-risk conditions. Increased prenatal care participation may help decrease preterm birth rates and also narrow the black-white twin preterm birth disparity.

Black People↗
PubMed1994

Promoting prenatal care: what do community leaders know and believe about it? (community leader beliefs about promotion).

Community leaders directly affect prenatal services in their local communities. Twenty-nine leaders in an urban community and 47 in a rural community in Wisconsin were interviewed to determine their knowledge and beliefs about and intent to promote prenatal care for low-income women in their communities. The findings showed that leaders generally assigned high importance to prenatal care for low-income women and intended to promote it during the next six months; and they demonstrated good general knowledge about prenatal care and perceived broad-based community support for their decision to promote it. Disturbingly, many community leaders did not know what percentage of local pregnant women entered prenatal care late or how many medical care providers were available to their constituents on Medicaid, cost was cited as a disadvantage to promoting prenatal care for low-income women, and several leaders in both communities believed that promoting prenatal care would result in low-income women wanting to have more babies or increasing their dependence on free programs. Public health nurses can use the findings of this study in their work with community leaders to ensure prenatal services for low-income populations.

Community Participation↗
PubMedDate not supplied

Barriers to prenatal care among Black women of low socioeconomic status.

OBJECTIVE: To qualitatively identify attitudinal and psychosocial determinants of early prenatal care among Black women of low socioeconomic status (SES). METHODS: Focus group discussions were conducted among Black women who attended community clinics for prenatal care. RESULTS: Early initiators of prenatal care, compared with late initiators, had positive attitudes toward pregnancy, were knowledgeable about pregnancy signs/symptoms, and thought prenatal care was important. All participants indicated strong social support during pregnancy. Late initiators, particularly multiparous women, perceived clinic staff to be insensitive. CONCLUSIONS: Findings provide valuable insight into overcoming barriers to early initiation of prenatal care among low SES Black women.

Adolescent↗
PubMed1997

Prenatal care and infant lead exposure.

OBJECTIVE: The objective of the study was to determine the relation between prenatal care of mothers and blood lead concentrations in their offspring in the first year of life. METHODS: A retrospective survey was conducted of 200 predominantly black infants between the ages of 6 and 22 months (mean age, 13.4 months). The infants had been screened for the first time since birth at the Charleston County (South Carolina) Health Department. They resided in a neighborhood with the highest prevalence of lead poisoning in Charleston. Prenatal care use data were obtained after matching birth records with lead-screening records. RESULTS: Seventy-three infants (37%) had blood lead levels 0.48 micromol/L (> or = 10 microg/dl) or higher. Adequacy of prenatal care, defined by the Modified Kessner Index, showed 11% with intensive care (26% of these with high lead levels), 39% with adequate care (35% high blood lead levels), 35% with intermediate care (40% with high blood lead levels), 13% with inadequate care (42% with high blood lead levels), and 2% with no prenatal care (25% with high blood lead levels). With the exception of the small group with no prenatal care (n = 4), the proportion of infants with a high blood lead level was inversely proportional to the level of care. The logistic regression model that best fit the data included age at screen for lead and birth weight. Low birth weight babies (<2500 gm) were more likely to have a high blood lead level at primary screen than babies who were heavier at birth (odds ratio, 2.60; p = 0.04), and the older the baby at screening, the greater the likelihood of a high blood lead level (odds ratio, 1.23; p = 0.01). There was a trend for black infants to have a high blood lead level more often than white infants (odds ratio, 3.05; p = 0.06). CONCLUSIONS: Less than adequate use of prenatal care may reflect an increase in risk factors contributing to lead exposure in infancy. Low birth weight also was related to high blood lead levels. Further studies are required to differentiate among several hypotheses for this effect. Intrauterine lead exposure, which is known to reduce birth weight, may contribute to measured blood lead levels at first screen. Alternatively, low birth weight may increase lead absorption and retention in infancy or may increase risk of lead exposure.

Analysis of Variance↗