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PubMed2006

The impact of prenatal care on birthweight: the case of Uruguay.

This study analyzes prenatal care and birthweight in Uruguay. These data are unique since they represent a population of urban, poor women who gave birth in a health care system that provides both prenatal and obstetric care free of charge. This study finds a positive effect of increased prenatal care use on birthweight and evidence of bias in OLS estimates, similar to studies that use US data. The results highlight the usefulness of existing methodologies for estimating the effect of prenatal care on birthweight and the importance of extending these methodologies to data from countries other than the US.

Birth Weight↗
PubMedDate not supplied

[Prenatal care in Pelotas, Rio Grande do Sul, Brazil, 1993].

All 5304 births in the hospitals of Pelotas, Rio Grande do Sul, Brazil in 1993 were studied. Neonates were examined and their mothers were interviewed regarding sociodemographic conditions, family income, reproductive health, and medical care during pregnancy. Ninety-five per cent of women received prenatal care. The mean number of physician visits during pregnancy was 7 and the majority of the women (84.7%) began visits before the fifth month of pregnancy. Women who did not receive prenatal care were from the lowest socioeconomic stratum and were mostly adolescents or over 40 years of age. Incidence of low birth weight in this group was 2.5 times that of the group with more than five visits (p>0.001). Perinatal mortality rate was 50.6/1000 in the group without prenatal care and 15.8/1000 in the group with more than five visits. With regard to utilization of health care, the study shows that twenty-five per cent of women with high gestational risk received inadequate prenatal care. The rate was less than 10% in the group of women with low gestational risk. These results suggest the need for improvement in the quality of prenatal care with special attention for mothers with high gestational risk.

Adolescent↗
PubMed1991

Factors which influence use of prenatal care in low-income racial-ethnic women in Los Angeles County.

There is very limited information on ethnic differences in use of prenatal care services. The purpose of this study was to examine the effect of sociodemographic, health behaviors, medical risk, and psychosocial risk factors on the timing of prenatal care among Black-American, Mexican-American, and recent Mexican immigrant women in Los Angeles. A sample of 107 primiparous women were interviewed using a structured questionnaire. Information obtained included socioeconomic indicators, relationship with baby's father, timing of prenatal care, psychosocial factors, and substance use before pregnancy. Ethnic patterns of timing of prenatal care revealed no significant differences. The relationship with the baby's father was associated with early timing of prenatal care and more prenatal care visits. Substance use before pregnancy was significantly related to total number of visits for this pregnancy.

Adult↗
PubMedDate not supplied

Deaf women's experiences and satisfaction with prenatal care: a comparative study.

BACKGROUND AND OBJECTIVES: The quality of communication between physician and patient is a major contributor to patient satisfaction and treatment adherence. Deaf patients who use American Sign Language experience significant communication barriers in most medical settings. This study investigated factors impacting deaf patients' satisfaction with prenatal care and prenatal care disparities between deaf and hearing women. METHODS: Questionnaires modified from Omar and Schiffman's prenatal satisfaction measure were administered to 23 deaf and 32 hearing women. RESULTS: Deaf women were less satisfied than hearing women with physician communication and less satisfied with overall care. Deaf women's expectations about provision of interpreter services being met or exceeded was significantly associated with overall satisfaction. Hearing women had more prenatal care appointments and reported receiving more information from their doctors. CONCLUSIONS: Maximizing communication effectiveness with deaf patients results in better prenatal care and improved patient satisfaction. Good communication includes conveying concern and making efforts to ensure that whatever communication methods used are effective.

Communication Barriers↗
PubMed1998

Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus.

OBJECTIVE: To evaluate the effectiveness of an intervention designed to enhance Medicaid prenatal care in improving birth outcomes of drug-using women infected with the human immunodeficiency virus (HIV). METHODS: Medicaid and vital statistics records were linked for 353 HIV-infected drug-using women delivering in 1993 and 1994 while enrolled in New York State Medicaid. Of these, 68% were treated by providers participating in the Prenatal Care Assistance Program, designed to provide case management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks), comparing women using and not using the program. RESULTS: Women using the Prenatal Care Assistance Program were significantly less likely, after adjustments were made for maternal characteristics, to have low birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0.89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explained just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care, and drug use treatment variables altered program effect estimates less profoundly (together accounting for 4 and 9% of the program's protection against low birth weight and preterm delivery, respectively). CONCLUSION: The Prenatal Care Assistance Program appeared to be successful in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, to a lesser extent, to more frequent receipt of special services and reduced maternal high-risk behaviors.

Adult↗
PubMed2000

The effect of integrating substance abuse treatment with prenatal care on birth outcome.

OBJECTIVE: To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes. STUDY DESIGN: The subjects were women who voluntarily enrolled in Project Link, an intensive outpatient substance abuse treatment program at Women and Infants Hospital, Providence, RI. A total of 87 women received substance abuse treatment in conjunction with their prenatal care; the comparison group of 87 women received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered. The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories. Univariate and multivariate analyses were performed. The key outcomes were gestational age at delivery, birth weight, preterm delivery, Apgar scores, and neonatal intensive care admission rate. Factors controlled in the multivariate models included demographics, socioeconomic status, parity, and prenatal care. RESULTS: Infants born to women who enrolled prenatally were 400 gm heavier (p < 0.001), and their gestational age was 2 weeks longer (p < 0.001) than infants of mothers enrolled postpartum. In addition, they were approximately one-third as likely to be born with a low birth weight (p < 0.01) and approximately one-half as likely to be admitted to the neonatal intensive care unit (p < 0.05). CONCLUSION: Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum.

Adolescent↗
PubMed1996

Factors related to the initiation of prenatal care in the adolescent nullipara.

The purpose of this cross-sectional descriptive study was to explore factors that influence the timing of the first prenatal care visit of pregnant adolescents. Although researchers agree that barriers to prenatal care need to be identified and interventions formulated, barriers have not been well defined for any specific population. Increased availability and adequacy of health care resources, more family system support, and higher self-care agency scores are hypothesized to predict earlier prenatal care. A convenience sample of 51 pregnant adolescents from a university clinic was surveyed. The study found that the availability/adequacy of health care resources was the most significant predictor of the initiation of prenatal care (p = .03). Of the various health care resources assessed, only the ease in attaining a medical card was positively related to the onset of prenatal care. Practitioners can be instrumental in disseminating information about the availability of health care resources and in easing access to those resources through local and national political involvement.

Adolescent↗
PubMed1993

Psychosocial determinants of late prenatal care: the Health Belief Model.

This paper presents a theoretical framework for investigating psychosocial determinants of delayed prenatal care among disadvantaged women. This framework is based on the Health Belief Model (HBM), which postulates that beliefs concerning prenatal care are modified by psychological and social attributes and may predispose one to delay prenatal care enrollment. The HBM has a number of advantages for family medicine researchers in comparison to other models; its use in future investigations can provide the understanding necessary for overcoming psychosocial deterrents to entry into prenatal care.

Attitude to Health↗
PubMed1996

Effects of prenatal care on neonates born to drug-using women.

This study examined whether prenatal care ameliorates the adverse effects of illicit drug use during pregnancy. We reviewed medical records of 336 women who delivered at the university hospital for results of urine drug screens, maternal history, infant outcome, and presence of prenatal care. Ninety-one women tested positive for illicit drugs, of whom 60 obtained prenatal care. We associated use of marijuana with increased risk of fetal distress; cocaine use with decreased birth weight, smaller head circumference, anemia, and meconium-stained amniotic fluid; and multiple drug use with decreased weight and meconium-stained fluid. Drug-using women who obtained prenatal care delivered infants of greater weight and with larger head circumferences than did those who obtained no care (p < .05). These results confirm the adverse effects of illicit drug use during pregnancy.

Adolescent↗
PubMed1979

The effects of prenatal care upon the health of the newborn.

Data upon all births and infant deaths in New York City in 1968 are analyzed using methods for the analysis of multidimensional contingency tables. These methods provide estimates of the effect of variations in prenatal care upon the relative risks of low birth weight and neonatal and postneonatal mortality, controlling for a wide variety of factors which tend to "select" women into a program of prenatal care. Significant relationships between lack of prenatal care and infant mortality are estimated, but these occur mainly via the relationship of inadequate prenatal care to low birth weight. Furthermore, among white mothers who delivered on a private service, those receiving inadequate levels of prenatal care experienced only slightly increased risks of a low birth weight infant. In contrast, white mothers who delivered on a general service, and all black mothers, experienced substantially increased risks when receiving inadequate prenatal care. A variety of behavioral characteristics of mothers were not controlled in these analyses, and thus clear causal inferences concerning the efficacy of prenatal care cannot be drawn. These analyses do, however, identify a significant population of women at substantial risk.

Adult↗
PubMed1994

Health status and timing of onset of prenatal care: is there an association among low-income women?

We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low-income women in Snohomish County, Washington. The investigation was a cross-sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low-income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The findings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low-income women.

Adult↗
PubMed2006

Does the quality of prenatal care matter in promoting skilled institutional delivery? A study in rural Mexico.

OBJECTIVES: To determine if the quality of prenatal care predicts skilled institutional delivery, a primary means of reducing maternal mortality. METHODS: The probability of skilled institutional delivery is predicted among 4173 rural low-income women of reproductive age in seven Mexican states, as a function of maternal retrospective reports about prenatal care services received in 1997-2003. RESULTS: Women who received most prenatal care procedures were more likely to have a skilled institutional delivery (OR 2.29, 95% CI 1.18, 4.44). Women who received less than the 75th percentile of prenatal care procedures were not significantly different from those who received no prenatal care. CONCLUSIONS: Policies promoting increased access to prenatal services should be linked to the promotion of practice standards to impact health and behavioral outcomes.

Adult↗
PubMed1990

Early prenatal care in urban black and white women.

If the ultimate success of efforts to improve pregnancy outcome depends on assurance that prenatal care begins in the first trimester, it is important to identify potentially modifiable factors associated with the start of care as well as the groups in which it is most likely to be late. This topic was explored in a population-based study of low birthweight in 766 black women and 462 white women who gave birth in Alameda County, California, in 1987. Variables related to insurance coverage and financial status showed the greatest difference between early and late attenders at prenatal care in both groups. At virtually every level of almost every variable studied, black women were less likely than white women to begin prenatal care in the first trimester. The data suggested that some of the difference in the timing of prenatal care may be due to lack of awareness of, or failure to pay attention to, the signs of early pregnancy. We conclude that, although addressing problems of insurance coverage and financial status is critical to the solution of the problem of late initiation of prenatal care, as financing difficulties are solved, attention should be paid to women's internal factors such as depression and denial as modifiers of the earliness of seeking prenatal care.

Adolescent↗
PubMed1998

Prenatal care.

This paper describes the psychological and psychosocial aspects of prenatal care, which are believed to be of particular importance for medical/psychological practice. The emotional changes that "normally" take place during pregnancy are surveyed and evidence is provided linking these changes with potential adverse effect on pregnancy and labour. The salience of anxiety and life stresses in pregnancy research is highlighted as well as their intricate inverse relationship with social support. Antenatal classes are offered as an example of social support provision. The different kinds of such classes and evaluation of their effectiveness are briefly presented, as well as a number of controlled trials of enhanced support during pregnancy. Finally, the effect provision of prenatal care has on women as well as their role in their own care are raised. The need is stressed for further sophisticated longitudinal and multivariate research exploring further the causative links between quality of prenatal care, pregnancy outcome, and subsequent child development.

Adult↗
PubMed1989

The effect of social support on prenatal care.

This article examines the effects of social support on the receipt of adequate prenatal care. A study was conducted to test the hypotheses that social support helps women overcome obstacles to obtaining such care, and that social support has greater effects on women facing the most obstacles. Survey data were gathered for more than 90% of the women who gave birth in Oklahoma hospitals during specific periods in the summer of 1986. The authors found only weak support for the first hypothesis, and for the second hypothesis found only support that must be qualified according to the measure of social support. Strong evidence indicates, however, that difficulty in paying for prenatal care, personal inconveniences, and unwanted pregnancies are obstacles to obtaining such care. The findings account for some of the frequently observed demographic differences associated with receipt of adequate prenatal care, although such differences persisted even after the obstacles were considered. The authors present implications for policy makers seeking to improve women's receipt of adequate prenatal care.

Age Factors↗
PubMed2002

Quality improvement efforts in prenatal care for Oklahoma Medicaid managed care patients: 1995-1998.

The Oklahoma Health Care Authority and the Oklahoma Foundation for Medical Quality analyzed documented patterns of care in the Oklahoma Medicaid urban managed care plans from 1995 through 1998. In 1995, 31.3% of the patients had started prenatal care in the first trimester, and 50.6% of the patients had first trimester prenatal care in 1998. No prenatal care was noted for 3.2% in 1995, which decreased to 2.9% for 1998. For 1995, 23.9% of the deliveries were operative and 20.8% for 1998. Similarly, the vaginal delivery after previous C-section (VBAC) rate was 36.5% for 1995, and increased to 41.0% in 1998. Very low birth weight (defined as below 1500 grams) rates were 3.7% for 1995 and 1.3% for 1998, while the low birth weight (between 1500 and 2499 grams) infants were recorded for 7.8% of the live births in 1995, and for 1998, 7.5%. While there has been improvement in rates over the four years of the study, opportunities for improvement in the provision of the prenatal care for the Oklahoma Medicaid managed care population remain.

Female↗
PubMed2004

The effect of prenatal care on birthweight: a full-information maximum likelihood approach.

This paper uses a full-information maximum likelihood estimation procedure, the Discrete Factor Method, to estimate the relationship between birthweight and prenatal care. This technique controls for the potential biases surrounding both the sample selection of the pregnancy-resolution decision and the endogeneity of prenatal care. In addition, we use the actual number of prenatal care visits; other studies have normally measured prenatal care as the month care is initiated. We estimate a birthweight production function using 1993 data from the US state of Texas. The results underscore the importance of correcting for estimation problems. Specifically, a model that does not control for sample selection and endogeneity overestimates the benefit of an additional visit for women who have relatively few visits. This overestimation may indicate 'positive fetal selection,' i.e., women who did not abort may have healthier babies. Also, a model that does not control for self-selection and endogenity predicts that past 17 visits, an additional visit leads to lower birthweight, while a model that corrects for these estimation problems predicts a positive effect for additional visits. This result shows the effect of mothers with less healthy fetuses making more prenatal care visits, known as 'adverse selection' in prenatal care.

Birth Weight↗
PubMed1993

Comparison of adolescent pregnancy outcomes by prenatal care source.

To determine whether a difference existed in prepregnancy characteristics, pregnancy course and immediate outcomes of pregnant adolescents based on source of prenatal care, we retrospectively reviewed the pregnancies of all adolescents aged < or = 17 years who delivered from 1985 to 1986 at The University of Texas Medical Branch, Galveston. The sample of 1,080 included 660 (61%) teenagers who participated in a teen pregnancy clinic, 277 (26%) teenagers who participated in traditional prenatal care and 143 (13%) who received no prenatal care. Teen clinic participants differed from the other two groups in that they were more likely to be unmarried (P = .02) and to be primagravidae (P = .05). Teenagers receiving care were also of higher gynecologic age than those not receiving care (P = .02). Ethnic distribution, chronologic age, education completed and smoking behavior were similar among the three groups. Although teen clinic participants began prenatal care earlier and had more visits than traditional care participants, both groups had similar pregnancy outcomes. Groups receiving prenatal care had better outcomes (Apgar scores, preterm births, low and very low birth weight) than those who received no care.

Adolescent↗