Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PRENATAL CARE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Determinants of prenatal care use in Hawaii: implications for health promotion.

This study examines the association between maternal sociodemographic characteristics and the receipt of different levels of prenatal care use (no care, inadequate, intermediate, adequate) in order to determine different patterns in the relationships between maternal characteristics and these distinct categories of prenatal care use. Using the 1979-1992 Hawaii live birth vital record file, single live births to Hawaii resident mothers of white, Hawaiian/part-Hawaiian, Filipino, or Japanese ethnicity, who did not indicate on the birth certificate that either parent was active duty military, were selected. Over one quarter of this study population did not initiate prenatal care in the first trimester. Given the high level of insurance coverage found in Hawaii, this finding is disconcerting, particularly in relation to the U.S. Year 2000 Objective of 90% initiation in the first trimester. Overall, the factors that predicted receipt of any prenatal care predicted more adequate use of prenatal care as well. Noteworthy exceptions were maternal age and ethnicity. Identifying these exceptions is important for the development of a more detailed understanding of risk factors related to use of prenatal care to better target program responses aimed at improving prenatal care use. In addition, these data suggest that removing financial barriers to access to care does not guarantee universal use of disease prevention and health promotion services.

Adolescent↗
PubMed1999

The impact of personal problems on accessing prenatal care in low-income urban African American women.

OBJECTIVE: The purpose of this study was to investigate the nature and contribution of personal factors related to the use of prenatal care in a sample of high-risk women residing in an urban environment where care was accessible and free. STUDY DESIGN: The sample consisted of 297 African American women with low socioeconomic status and a high school education or less who were newly delivered of neonates. The level of prenatal care was classified according to the Kessner 3 Parameter Index (adequate, intermediate, inadequate). Women who received no prenatal care made up a fourth group. Subjects responded to the "Ten-Item Checklist" of Richwald. Rhodes, and Kersey and an in-person interview that queried their reasons for obtaining different levels of prenatal care. RESULTS: Both personal and structural reasons were described by women for not obtaining care earlier in pregnancy or at all. The mean number of personal and structural problems reported per subject was inversely correlated to the level of prenatal care obtained. However, personal problems were the single most important reason cited by these women. Personal problems that were statistically significant different among the groups were drug use and desire for an abortion. The structural barriers that exhibited statistically significant differences among the groups were trouble scheduling an appointment, access totransportation, dislike of health care professionals and institutions, access to child care, and not knowing where to go. CONCLUSION: Both personal and structural problems were cited as reasons for not obtaining adequate prenatal care. Structural barriers to prenatal care have been identified and extensively studied. These barriers to care continue to persist, despite innovations in program delivery and access. This study demonstrates that the significance of personal problems has not been adequately considered as a major factor associated with insufficient prenatal care.

Adult↗
PubMed2001

Group approach to prenatal care garners enthusiasm among patients and providers.

Without a marketing plan or fanfare, a group-care model aimed at delivering prenatal care to women with common concerns has gained an established foothold in at least 20 health care settings. Further, the Centering Pregnancy model is now getting new attention from researchers because of the potential benefits it may offer to teen groups and other ethnic populations. See how this self-empowering plan of care works, and why many satisfied patients and providers prefer it over more traditional prenatal care delivery.

Adolescent↗
PubMed1992

An inner-city community's perspective on infant mortality and prenatal care.

Neither expanded Medicaid eligibility nor case-finding approaches have significantly increased use of early prenatal care. Failure to improve use points to the importance of further study of the broader community's perspectives on prenatal care and perinatal health issues. A convenience sample of 380 low-income, inner-city, black adults were interviewed with respect to their understanding of infant mortality, perceived barriers to and importance of prenatal care, and recommended numbers of prenatal visits. All respondents reside in a community with negative indexes of perinatal health as measured by infant mortality, low birthweight, and average number of prenatal visits. Fifty percent of the sample could correctly define the term infant mortality. The majority believed that prenatal care is very important and should begin in the first trimester of pregnancy. Respondents recommending the least number of prenatal visits (0-6) perceived financial, institutional, and attitudinal factors as barriers to care. Pregnant women's fear of detection of drug use was the most salient barrier regardless of the recommended number of prenatal visits, age, sex, employment status, or number of children. Changing health problems mandate continued monitoring of community perceptions and expectations of services such as prenatal care. Public health nursing is ideally positioned to articulate community values to policy makers and health care professionals concerned with perinatal health.

Adult↗
PubMed1993

Access to prenatal care following major Medicaid eligibility expansions.

OBJECTIVE: To determine whether lack of financial access was a significant barrier to prenatal care following major expansions of Medicaid eligibility in California. DESIGN: Retrospective analysis of birth certificates, assessing risks of inadequate prenatal care by insurance, controlling for maternal race/ethnicity, birthplace, age, parity, education, and marital status. SAMPLE: Singleton live births to California residents occurring in-state in 1990 (N = 593,510). OUTCOME MEASURES: Untimely initiation of care, two few visits, and no prenatal care. RESULTS: Despite major Medicaid expansions, nearly 11% of live births were uninsured for prenatal care. Being uninsured and having Medi-Cal were both risk factors of sizable magnitude, controlling for maternal characteristics. Compared with women who had private fee-for-service coverage, uninsured women were at elevated risk of untimely initiation (odds ratio [OR], 2.54; 95% confidence interval [CI], 2.47 to 2.60) and too few visits (OR, 2.49; 95% CI, 2.44 to 2.55). Women with Medi-Cal had a high risk of untimely care (OR, 3.33; 95% CI, 3.26 to 3.40); their risk of too few visits was also elevated (OR, 1.63; 95% CI, 1.60 to 1.66) but less than for the uninsured. Lack of private insurance was a strong risk factor for no care (OR, 6.70; 95% CI, 6.00 to 7.47). CONCLUSIONS: In spite of major Medicaid expansions, access to prenatal care was limited for women without private insurance. Medicaid was associated with untimely entry but with improved continuity. The findings suggest that financial barriers were salient even when controlling for many factors related to care-seeking behavior. Policy initiatives need to address continuing financial barriers along with other obstacles.

Adolescent↗
PubMed2002

The impact of prenatal care on postneonatal deaths in the presence and absence of antenatal high-risk conditions.

OBJECTIVE: This study was undertaken to determine the association, if any, between prenatal care and postneonatal death in the presence and absence of high-risk pregnancy conditions. STUDY DESIGN: Data were derived from the national linked birth/infant death data set for the years 1995 to 1997 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation. Multiple births, congenital malformations, chromosomal abnormalities, missing data on gestational age, and birth weight less than 500 g were excluded. Multivariable logistic regression analyses were used to adjust for various antenatal high-risk conditions, maternal age, gravidity, gestational age at delivery, birth weight, maternal education, marital status, smoking, and alcohol use. Postneonatal death rate was defined as the number of deaths between 28 and 365 days of life per 1,000 neonatal survivors. RESULTS: For 10,512,269 singleton live births analyzed, 21,962 (2.1 per 1,000) resulted in postneonatal death. Postneonatal death rates were higher for African American women than white women in the presence (3.8 vs 1.7 per 1,000) and absence (11.2 vs 5.3 per 1,000) of prenatal care. Lack of prenatal care was associated with increased relative risk (RR) for postneonatal death, 1.8-fold in African American women and 1.6-fold in white women. Lack of prenatal care was associated with increased postneonatal death rates to a similar degree for the individual high-risk pregnancy conditions for both African American and white women. Lack of prenatal care was associated with increased postneonatal death rates, especially in the presence of postterm pregnancy (RR 2.3, 95% CI 1.6, 3.1), pregnancy-induced hypertension (RR 2.2, 95% CI 1.5, 3.4), intrapartum fever (RR 2.1, 95% CI 1.2, 3.5), and small-for-gestational-age infant (RR 1.6, 95% CI 1.3, 2.0). CONCLUSION: Lack of prenatal care should be considered as a high-risk factor for postneonatal death for both African American and white women, especially if the pregnancy has been complicated by postdates, pregnancy-induced hypertension, intrapartum fever or small-for-gestational-age infant.

Black or African American↗
PubMed1999

Adequacy of prenatal care and prescription of zidovudine to prevent perinatal HIV transmission.

In 1994, data were published on the effectiveness of zidovudine in preventing perinatal transmission of HIV infection. Using data from surveillance projects in San Antonio, Dallas, and Houston, Texas, U.S.A., we linked records of children born from 1987 through 1996 with records of their HIV-infected mothers. Prenatal care was measured by Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index. We examined the association between adequacy of prenatal care and four measures of zidovudine prescription: prenatal, intrapartum, neonatal, and the complete regimen. Inclusion criteria was that the mother's HIV infection was diagnosed before a live birth; 221 mother-infant pairs were included in the analysis. Overall, 68% received inadequate or no prenatal care. Over time, the proportion of mother-infant pairs with adequate prenatal care doubled (24%-48%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3-3.0), and the proportion prescribed prenatal zidovudine tripled (20%-67%; RR, 3.4; 95% CI, 2.4-4.9). In logistic regression, APNCU (adjusted odds ratio [aOR], 2.6; 95% CI, 1.1-6.2) and time period (aOR, 19.9; 95% CI, 8.1-48.7) were associated with prenatal prescription of zidovudine. The benefits of prenatal care, including HIV testing and zidovudine treatment, underscore the urgent need to improve access to and use of prenatal care services.

Adult↗
PubMed2002

The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions.

OBJECTIVE: This study was undertaken to determine the association between prenatal care in the United States and preterm birth rate in the presence, as well as absence, of high-risk pregnancy conditions for African American and white women. STUDY DESIGN: Data were derived from the natality data set for the years 1995 to 1998 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred at >/=20 weeks' gestation. Multiple births, fetal deaths, congenital malformations, chromosomal abnormalities, missing data on gestational age, and birth weight less than 500 g were excluded. Multivariable logistic regression analyses were used to adjust for the presence or absence of various antenatal high-risk conditions, maternal age, gravidity, marital status, smoking, alcohol, and education. Prenatal care was considered present if there was one or more prenatal visits. Preterm delivery was defined as delivery at less than 37 completed weeks of gestation. RESULTS: For 14,071,757 births analyzed, 1,348,643 (9.6%) resulted in preterm birth. Preterm birth rates were higher for African American women than white women in the presence (15.1% vs 8.3%) and absence (34.9% vs 21.9%) of prenatal care. The absence of prenatal care increased the relative risk for preterm birth 2.8-fold in both African American and white women. There was an inverse dose-response relationship between the number of prenatal visits and the gestational age at delivery both among African American and white women. Lack of prenatal care was associated with increased preterm birth rates to a similar degree in the presence of pregnancy complications for both African American and white women, ranging from 1.6-fold to 5.5-fold for the various antenatal high-risk conditions. CONCLUSION: In the United States, prenatal care is associated with fewer preterm births in the presence, as well as absence of high-risk conditions for both African American and white women. Strategies to increase prenatal care participation may decrease preterm birth rates.

Black or African American↗
PubMed1987

Source of prenatal care and infant birth weight: the case of a North Carolina county.

The impact of a comprehensive prenatal care program on the birth weights of infants born to low-income women is assessed. Women receiving care through the prenatal program of a large county public health department were compared to pregnant Medicaid-eligible women in the same county, who received prenatal care primarily from private-practice physicians. The percentage of low birth weight was 8.3 for the health department women compared with 19.3 for the Medicaid women. After differences between the two groups in race, marital status, participation in the Special Supplemental Food Program for Women, Infants, and Children (WIC), quantity of prenatal care, and other risk factors were statistically controlled, the chance of a Medicaid woman having a low-weight birth was still more than twice as great (p = 0.007). A case-management approach and greater use of services ancillary to basic obstetric medical care appear to contribute to the better birth weight outcomes in the health department.

Birth Weight↗
PubMed1992

Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight.

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatal care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, paraprofessional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers.

Birth Weight↗
PubMed2002

[Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa].

Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries. Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning. These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect. Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.

Africa South of the Sahara↗
PubMed2005

Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.

Adolescent↗
PubMed1994

Pregnancy among American Indian adolescents: reactions and prenatal care.

PURPOSE: Adolescent childbearing is twice as common among Native Americans as among all US races combined. Despite this, little is written about the psychosocial context or prenatal care of pregnant Native American adolescents. The objective of this study was to explore the reactions and prenatal care of Navajo and Apache adolescents delivering infants at Shiprock Indian Hospital, New Mexico, between January and March 1991, and Whiteriver Indian Hospital, Arizona, between May and June 1991. METHODS: Of the 25 eligible adolescents aged 19 years and younger, 15 Navajo and 5 Apache participants were interviewed within 24 hours of delivery. The interview consisted of 121 questions divided into 5 areas: sociodemographics, personal and family reactions to the pregnancy, knowledge and attitudes toward prenatal care, barriers to care, and ways to improve access to care. RESULTS: The mean age was 17.4 +/- 1.1, 6 were married, and 13 were primiparous. According to the Maternal Health Services Index, 5 adolescents received adequate, 13 intermediate, and 2 inadequate prenatal care. During the pregnancy, 3 adolescents used tobacco, 3 used alcohol, and none admitted to other drugs. Although only 1 adolescent planned the pregnancy, 15 were not using contraception when they became pregnant. In exploring reactions to the pregnancy, 13 adolescents were afraid to tell their families and 4 concealed the pregnancy until confronted. During the pregnancy, 7 adolescents described loneliness and 6 expressed suicidal ideation. Although over half reported no barriers to obtaining prenatal care, barriers that were noted by the remainder included transportation, family problems, and missing school. CONCLUSION: We conclude that pregnancy among many American Indian adolescents is unplanned and characterized by uncertainty and fear of disclosure, resembling the reactions to pregnancy of other adolescent populations. Furthermore, despite universal access to health services, many American Indian adolescents continue to experience barriers to care and receive intermediate or inadequate prenatal care. These preliminary findings suggest further research may help clarify how adolescent reactions to pregnancy and knowledge of prenatal care affect health care utilization.

Adolescent↗
PubMedDate not supplied

Racial disparities in pregnancy outcomes: the role of prenatal care utilization and maternal risk status.

Distinct black-white differences in pregnancy outcome and prenatal care utilization have been a persistent feature of U.S. natality-related statistics. Using South Carolina and North Carolina live birth-infant death cohort files for 1978-1982, this study examines the extent to which variations in prenatal care utilization may be associated with racial disparities in pregnancy outcome within maternal sociomedical risk groups. After taking indicators of maternal risk into account (age-parity, education, marital status, complications of pregnancy and previous pregnancy terminations), birth weight and gestational age distributions and birth weight- and gestational age-specific neonatal mortality rates of blacks and whites were compared by level of prenatal care utilization. Distinct racial differences in birth weight and gestational age distributions were observed within equivalent maternal risk and prenatal care categories, with whites having an approximately 200-gram mean birth weight and five-day mean gestational age advantage compared to blacks. In this analysis of more than 650,000 cases, low-risk blacks adequately utilizing prenatal care had a lower mean birth weight (3,266 grams) and a higher neonatal mortality rate (6.6) than low-risk, inadequate-care whites (3,302 grams; 6.1).

Black or African American↗
PubMed1994

Self-esteem, social support, and satisfaction differences in women with adequate and inadequate prenatal care.

This descriptive, retrospective study examined levels of self-esteem, social support, and satisfaction with prenatal care in 193 low-risk postpartal women who obtained adequate and inadequate care. The participants were drawn from a regional medical center and university teaching hospital in New Mexico. A demographic questionnaire, the Coopersmith self-esteem inventory, the personal resource questionnaire part 2, and the prenatal care satisfaction inventory were used for data collection. Significant differences were found in the level of education, income, insurance, and ethnicity between women who received adequate prenatal care and those who received inadequate care. Women who were likely to seek either adequate or inadequate prenatal care were those whose total family income was $10,000 to $19,999 per year and high school graduates. Statistically significant differences were found in self-esteem, social support, and satisfaction between the two groups of women. Strategies to enhance self-esteem and social support have to be developed to reach women at risk for receiving inadequate prenatal care.

Adult↗
PubMed2003

Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics.

OBJECTIVE: To examine the impact of group versus individual prenatal care on birth weight and gestational age. METHODS: This prospective, matched cohort study included pregnant women (N = 458) entering prenatal care at 24 or less weeks' gestation; one half received group prenatal care with women of the same gestational age. Women were matched by clinic, age, race, parity, and infant birth date. Women were predominantly black and Hispanic of low socioeconomic status, served by one of three public clinics in Atlanta, Georgia or New Haven, Connecticut. RESULTS: Birth weight was greater for infants of women in group versus individual prenatal care (P < .01). Among those born preterm, infants of group patients were significantly larger than infants of individual-care patients (mean, 2398 versus 1990 g, P < .05). Although not statistically significant, infants of group patients were less likely than those of individual-care patients to be low birth weight (less than 2500 g; 16 versus 23 infants); very low birth weight (less than 1500 g; three versus six infants); early preterm (less than 33 weeks; two versus seven infants); or to experience neonatal loss (none versus three infants). There were no differences in number of prenatal visits or other risk characteristics (patient age, race, prior preterm birth). CONCLUSIONS: Group prenatal care results in higher birth weight, especially for infants delivered preterm. Group prenatal care provides a structural innovation, permitting more time for provider-patient interaction and therefore the opportunity to address clinical as well as psychological, social, and behavioral factors to promote healthy pregnancy. Results have implications for design of sustainable prenatal services that might contribute to reduction of racial disparities in adverse perinatal outcomes.

Adolescent↗
PubMedDate not supplied

Association between early prenatal care and mother's intention of and desire for the pregnancy.

OBJECTIVE: To examine the associations between having planned to become pregnant and valuing an unintended pregnancy with seeking early prenatal care. DESIGN: This historical cohort study, using data from the National Survey of Family Growth (NSFG), Cycle V (1995), examined separately the associations of having a planned pregnancy (timing of pregnancy) and valuing an unintended pregnancy (feelings about the pregnancy) with timing of initiation of prenatal care. PARTICIPANTS: The NSFG was based on a national probability sample of women ages 15 to 44 (N= 1,989). OUTCOME MEASURE: Timing of initiation of prenatal care (early or late/no). Early prenatal care was defined as care sought within the first 13 weeks of pregnancy. It was hypothesized that unwanted and unintended pregnancies were predictors of late or no prenatal care. RESULTS: In agreement with previous research using logistic regression, unwanted pregnancy was found to be a predictor of late/no prenatal care. Black ethnicity also was found to be a predictor of late/no prenatal care. CONCLUSIONS: Interventions that are sensitive to culture and involve patient education regarding family planning are needed.

Adolescent↗
PubMed1996

Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial.

OBJECTIVES: In 1989, the Expert Panel on the Content of Prenatal Care established guidelines on the timing and content of prenatal care, including a schedule consisting of fewer prenatal visits than traditionally provided, for women at low risk of adverse perinatal outcomes. We tested the hypothesis that there are no significant increases in adverse perinatal outcomes when low-risk women are seen in a prenatal care visit schedule of fewer visits than routinely advised. DESIGN: Randomized controlled trial. SETTING: Group-model health maintenance organization. PATIENTS: A total of 2764 pregnant women, judged to be at low risk of adverse perinatal outcomes. INTERVENTIONS: Following risk assessment, participants were randomly assigned to an experimental schedule (nine visits) or a control schedule (14 visits) with additional visits as indicated or as desired by the patient. MAIN OUTCOME MEASURES: Preterm delivery, preeclampsia, cesarean delivery, low birth weight and patient's satisfaction with care. RESULTS: On average, there were 2.7 fewer visits observed in the experimental group than in the control group. There were no significant increases in the main outcomes of the experimental group; preterm delivery (relative risk [RR], 1.08; 95% confidence interval [CI], 0.92 to 1.27; P = .19), preeclampsia (RR, 0.94; 95% CI, 0.78 to 1.14, P = .74), cesarean delivery (RR, 1.04; 95% CI, 0.93 to 1.17; P = .25), and low birth weight (RR, 0.94; 95% CI, 0.78 to 1.12; P = .76). There were no differences between the two groups in patients' satisfaction with quality of prenatal care. CONCLUSION: In this study, good perinatal outcomes and patient satisfaction were maintained when the prenatal visit schedule proposed by the Expert Panel on the Content of Prenatal Care was observed.

Adult↗