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PubMedDate not supplied

Barriers to prenatal care in a multiethnic, urban sample.

The barriers that prevent women from obtaining prenatal care were studied in a multiethnic, primarily indigent urban population. Two thousand nine hundred eighty-seven women were delivered at the University of Miami/Jackson Memorial Medical Center from January 15 to April 10, 1988. Of these women, 227 (7.6%) did not access any prenatal care. These women formed the study group. The results indicated that the main barriers were systematic (35.5%), patient-related (35.5%), and financial (29%). Ethnic group, marital status, and education influenced access to prenatal care, whereas age did not appear to do so. Although low birth weight rates were higher in the study group, it was apparent that cultural behavior influenced birth weight, whether or not prenatal care was obtained.

Adolescent↗
PubMed1984

The effect of maternal age, parity, and prenatal care on perinatal outcome in adolescent mothers.

Maternal age and prenatal care were found to influence the risk for having a small-for-gestational age infant in white adolescent mothers who had both one and two previous live births. However, poor care exerted a relatively stronger affect than young age for primiparous mothers, while the reverse was found for multiparous mothers. Moreover, for women with first births, there was an interaction between variables in that early prenatal care promoted better pregnancy outcome for younger teenagers than for older teens or adults. These results indicate that the perinatal risks of adolescent pregnancy are affected by both physiologic factors and prenatal care.

Adolescent↗
PubMed1994

Prenatal care access and pregnancy outcomes in Missouri.

Women's access to prenatal care and perception of barriers to obtaining care were acquired from data derived from the 1990 NICHD/Missouri Maternal and Infant Health Survey. Maternal surveys were available for 479 fetal deaths, 902 VLBW, 802 MLBW, and 919 normal birth weight infants. Very low birth weight mothers were less likely to receive prenatal care, perceived more barriers to obtaining prenatal care, and were more unhappy about their pregnancy than were the mothers of normal weight infants.

Female↗
PubMedDate not supplied

Framing the debate: can prenatal care help to reduce the black-white disparity in infant mortality?

Prenatal care has been identified as necessary to reducing the disparity in infant mortality between black and white infants. The purpose of this paper is to review determinants of the disparity and describe the contribution that prenatal care can make to modifying those determinants, biologic or social. When examined by birthweight categories, 25% of the disparity is due to excess deaths among normal birthweight infants (> or = 2500 g); 13% is due to excess deaths among moderate low birthweight infants (1500-2499g); and 62% of the disparity is due to excess deaths among very low birthweight infants. Normal birthweight black infants have higher rates of death due to infections, injuries, and sudden infant death syndrome. Very low birthweight black infants account for the increasing disparity in infant mortality. Social determinants of the disparity in infant mortality include the effects of poverty and the accompanying problems of limited access to health care services, preventive care, and good nutrition. Prenatal care may reduce the disparity by using both high-risk and population-based prevention strategies. This combination of strategies would identify and treat medically high-risk women before delivery and provide preventive care to all women, regardless of their risk status. Although both strategies have a potential for producing modest reductions, neither has proved to be effective.

Black or African American↗
PubMed1996

Prenatal care experiences and birth weight among Mexican immigrant women.

National studies indicate that Mexican immigrant women tend to have more positive birth outcomes than other groups, despite receiving relatively low levels of medical prenatal care. Our study-based on in-depth interviews with immigrant women who had recently given birth in Chicago-examines women's experiences seeking prenatal care. Qualitative findings contribute to understanding why many of these women received less than optimal care during pregnancy. The study also offers modest evidence that, despite overall positive birth outcomes and low levels of prenatal care, adequate prenatal care may make a difference in birth outcomes in this group. Suggestions are made concerning ways to improve access to adequate care, paying particular attention to the impact of migration and communication in prenatal care.

Adult↗
PubMed1989

The cost effectiveness of prenatal care in reducing low birth weight in New Hampshire.

This study calculates the cost effectiveness of adequate prenatal care in reducing the low birth weight rate for each of three socioeconomic groups of women: those with less than 12 years of education, those with 12 years, and those with more than 12 years. Target low birth weight rates for each group were those actually achieved by New Hampshire women receiving adequate prenatal care within respective education groups. The estimated total cost associated with low birth weight births among the 1981-1984 cohort of New Hampshire resident births was more than $38 million. With universal adequate prenatal care, the low birth weight costs would be less than $32 million, a cost savings of $6.5 million. Since the additional cost of providing adequate prenatal care to all women was estimated to be $2.5 million, the net cost savings were estimated to be $4 million, or $1 million per year. For each additional $1 spent on prenatal care, $2.57 in medical care costs would be saved.

Adult↗
PubMed1995

Women's reasons for not seeking prenatal care: racial and ethnic factors.

Our objective was to determine if there were differences in the reasons for not seeking early prenatal care among low-income black, Hispanic, and white women who had four or fewer prenatal care visits or care only in the third trimester, and who gave birth at Denver General Hospital in Colorado. Data were gathered from 606 women (48% Hispanic, 26% black, 26% white) after delivery, using a 188-item questionnaire and abstracted medical charts. The most important reasons for not seeking early prenatal care were attitudinal (47%), financial (26%), and structural and system problems (8.5%). Financial reasons were more important to white than to black or Hispanic women, and attitudinal reasons were more important to black and Hispanic than to white women. The analysis showed that education and marital status were sometimes confounding variables. Clear differences in reasons for not seeking prenatal care were reported by women of dissimilar racial and ethnic groups in this public hospital. Cultural variations in women's views should be taken into account in developing programs intended to improve prenatal care and pregnancy outcome in Denver.

Adult↗
PubMed1991

Prepaid versus traditional Medicaid plans: lack of effect on pregnancy outcomes and prenatal care.

Enrollment of Medicaid recipients into capitated, case-managed systems has been advocated as a method of controlling cost. We studied prenatal care and birth outcomes for women and children enrolled in Aid to Families with Dependent Children (AFDC) in two capitated programs in Santa Barbara, California and Jackson County, Missouri (Prepaid), compared with similar but fee-for-service comparison medical communities in Ventura County, California and St. Louis, Missouri (FFS). At the sites of care, 2,336 inpatient and 823 prenatal care records were abstracted. Women at all sites received fewer than the recommended number of prenatal visits. At no site did more than 40 percent of women receive prenatal care in the first trimester of pregnancy. Mean birth weight and proportion of children of low birth weight (less than 2,500 grams) were similar between the demonstration and comparison counties. Complications of pregnancy and cesarean section rates were also similar between demonstration and comparison counties. This study did not demonstrate a decreased quality of care provided to enrollees in capitated, case-managed Medicaid programs compared with fee-for-service. Basic prenatal care was provided only to some members of this population, regardless of the type of physician payment.

Adult↗
PubMed1986

National and state trends in use of prenatal care, 1970-83.

Using birth certificate data, national trends in prenatal care use are examined for White and Black mothers overall, as well as for 10 separate subgroups defined by marital status, maternal age, and educational attainment. The per cent of Black mothers with early prenatal care increased each year during the 1970s but the average annual percentage point increase for 1976-80 (1.2) was smaller than that for 1970-75 (2.3). Furthermore, the per cent of Black mothers with early care declined from 62.6 in 1980 to 61.4 in 1982 and remained at this lower level in 1983. Similar changes in trends were observed for all of the 10 Black subgroups despite substantial variation among the subgroups in the level of early prenatal care use. Analyses of state trends provide further evidence of a change in trend for Black mothers. For White mothers, average annual increases in the per cent with early care were similar for 1970-75 and 1976-80 (0.8 and 0.6 percentage points). In addition, the per cent with early care has remained stable since 1980.

Adolescent↗
PubMedDate not supplied

Prenatal care and low-birth-weight rates in urban and rural Wisconsin.

BACKGROUND: The intent of this investigation was to study the distribution of obstetric providers and prenatal care utilization in Wisconsin and analyze the potential impact of these factors on the frequency of low birth weight. METHODS: State perinatal vital statistics and physician professional association surveys were used to compare the frequency of low birth weight, physician distribution, and utilization of prenatal care in all 72 counties in Wisconsin. RESULTS: Despite higher rates of suboptimal prenatal care utilization among women residing in rural counties, low-birth-weight rates were no different. Very-low-birth-weight rates were actually higher for residents of urban counties compared with those in rural counties. When low birth weight was examined based on the rate of suboptimal prenatal care, a positive association was found only for urban counties. In rural counties there was no increase in low-birth-weight rates as the use of prenatal care declined. CONCLUSIONS: Inadequate prenatal care appears to be associated with low-birth-weight rates, but less so for women residing in rural counties when compared with those in urban counties.

Female↗
PubMedDate not supplied

Initiation of prenatal care by low-income Hispanic women in Houston.

OBJECTIVE: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy. METHODS: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care. RESULTS: A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby was associated with earlier initiation of care, as was having an eligibility card for hospital district services. Several barriers to care were mentioned by women on open-ended questioning, including long waiting times, embarrassment the physical examination, and lack of transportation. CONCLUSIONS: Recommendations for practice included decreasing the number of visits for women at low risk for poor pregnancy outcomes while increasing the time spent with the provider at each visit, decreasing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emphasizing specific messages about benefits to the baby, and increasing general health motivation to seek preventive care through community interventions.

Adolescent↗
PubMed2002

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

OBJECTIVE: The purpose of this study was to determine the association between prenatal care in the United States and the neonatal death rate in the presence and absence of antenatal high-risk conditions. STUDY DESIGN: Data were derived from the national perinatal mortality data sets for the years 1995 through 1997, which were provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation. Multivariable logistic regression analyses were used to adjust for the presence or absence of various antenatal high-risk conditions, maternal age, gestational age at delivery, and birth weight. RESULTS: Of 10,530,608 singleton live births, 18,339 (1.7/1000 births) resulted in neonatal death. Neonatal death rates (per 1000 live births) were higher for African American infants compared with white infants in the presence (2.7 vs 1.5, respectively) and absence (10.7 vs 7.9, respectively) of prenatal care. Lack of prenatal care was associated with an increase in neonatal deaths, which was greater for infants born at > or =36 weeks of gestation (relative risk, 2.1; 95% CI, 1.8, 2.4). Lack of prenatal care was also associated with increased neonatal death rates in the presence of preterm premature rupture of the membranes (relative risk, 1.3; 95% CI, 1.1, 1.5), placenta previa (relative risk, 1.9; 95% CI, 1.2, 2.9), fetal growth restriction (relative risk, 1.7; 95% CI, 1.2, 1.6), and postterm pregnancy (relative risk, 1.4; 95% CI, 1.0, 2.9). CONCLUSION: In the United States, prenatal care is associated with fewer neonatal deaths in black and white infants. This beneficial effect was more pronounced for births that occurred at > or =36 weeks of gestation and in the presence of preterm premature rupture of the membranes, placenta previa, fetal growth restriction, and postterm pregnancy.

Adult↗
PubMed1999

Late entry into prenatal care: the neighborhood context.

This study investigated individual and neighborhood factors associated with late entry into prenatal care. Data from 220,694 New York City birth certificates were linked with data from the 1990 census and other secondary sources to determine the effect of women's individual characteristics and their neighborhood context on timing of prenatal care entry. Results indicate that 15 percent of New York City's pregnant women entered prenatal care late and that residence in a distressed urban neighborhood significantly increased the risk of late initiation, even in a model controlling for individual risk factors. Implications for social workers include the importance of outreach and case management for pregnant women, the value of health and social policies targeting distressed urban neighborhoods, and the need to ensure that Medicaid managed care implementation fosters use of prenatal care. The findings also underscore the importance of continuing to strive for a policy that ensures lifelong universal access to health care.

Adolescent↗
PubMed1994

Associations of the Use of Prenatal Care with Low Birthweight in Asian Pacific Women in Hawaii.

PURPOSE. This study examines ethnic-specific differences in associations of inadequate use of prenatal care with poor birthweight outcomes to determine whether ethnic specific improvements in the use of prenatal care in a rural district could potentially reduce infant morbidity or mortality there. METHODS. Data from 1988 to 1990 birth certificates of the state of Hawaii were used to study Filipino, Hawaiian and Japanese births. Stratified multivariate logistic regression analyses of the association of inadequate use of prenatal care visits with low birthweight were performed for each group adjusting for potentially confounding sociodemographic risk characteristics. SUMMARY OF IMPORTANT FINDINGS. Results indicate that the adjusted odds of low birthweight for the Hawaiians in the rural district with inadequate amounts of prenatal care visits were higher than for those with adequate visits (OR 2.1; CI 1.4, 3.1) and those relative odds were higher than for Hawaiians in the rest of the state (OR 1.2; CI 1.1, 1.5). Births to Japanese women in the area had a similar pattern (OR 2.3, CI 0.97, 5.6; rest of state OR 1.2, CI 0.98, 1.5), but the ratios were not statistically significant. Births to Filipino women did not have the same pattern (OR 0.73, CI 0.34, 1.6; rest of state OR 1.4, CI 1.2, 1.6). MAJOR CONCLUSIONS. There is substantial heterogeneity in the associations of inadequate care use with poor birthweight outcomes in different groups of Asian Pacific women and in different locations in which they settle. RELEVANCE TO ASIAN AND PACIFIC ISLANDER AMERICAN POPULATIONS. Communities need to determine the associations of poor birth outcomes with poor prenatal care usage of Asian Pacific women to determine whether ethnic specific improvements in prenatal care could potentially improve such outcomes in their areas. KEY WORDS. pregnancy, health services research, outcome and process assessment (health care), regression analysis (logistic models), low birth weight, patient compliance.

Journal Article↗
PubMed1995

Cocaine using during pregnancy and low birth weight: the impact of prenatal care and drug treatment.

Cocaine use in pregnancy has been associated with low birth weight. Large population-based studies suggest that 5 to 7% of pregnant women have used cocaine, with much higher rates in low income inner-city women. Among 140 births at our institution of cocaine-using women, we found a lower rate of low birth weight in those who received prenatal care compared with those without prenatal care: 33 of 96 (34.3%) versus 23 of 44 (52.3%), P < .05. A review of the literature shows that comprehensive care, which includes both prenatal care and drug treatment, seems to be associated with better birth weight outcomes, particularly in women who stop their use in the first trimester. Prenatal care alone, however, is also associated with improved outcomes even if not specialized or linked to drug treatment.

Cocaine↗
PubMedDate not supplied

Family planning: an essential component of prenatal care.

This nation's traditional approach to improving maternal and infant health has been prenatal care. But evidence is mounting that additional progress in reducing maternal and infant morbidity and mortality will depend, at least in part, on the care that a woman receives before she conceives. The studies reviewed in this paper indicate that increasing the interval between deliveries and preventing or delaying pregnancies among women at high risk could lower the rate of low birthweight (LBW). Since reducing the rate of unintended pregnancies would also reduce the number of pregnancies in women at high risk of LBW because of race, age, late or no prenatal care, and unhealthy behaviors, the prevention of unintended pregnancies would also reduce LBW. Unfortunately, prenatal care, as experienced by many women, devotes little attention to these family planning issues. Many women do not realize the importance of family planning to their own health and that of their children. Prenatal care providers should include instruction about the importance of pregnancy planning and encourage women to continue receiving health care between pregnancies. If the health of women and infants is to be improved, society must be willing to provide health services to women of reproductive age even when they are not pregnant.

Birth Intervals↗
PubMed1981

Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis.

We studied the use of prenatal care and pregnancy outcome in 4,148 deliveries among members of a well-established health maintenance organization (HMO) and 19,116 births among the 1973-1974 White birth cohort in the Portland, Oregon area. Mothers in the HMO were almost one year older on the average, slightly better educated, and less frequently unmarried, but had virtually identical past pregnancy histories when compared with the general population cohort. HMO members began prenatal care one month later and had three fewer visits than the general population (p less than .01); 78 per cent of the general population and only 64 per cent of HMO members began prenatal care in the first trimester (p less than .01). With maternal risk held constant, low birthweight, neonatal mortality, and infant mortality were 1.5 to 5 times greater with late, less frequent prenatal care than with early, frequent care. Multivariate analysis demonstrated a positive relationship between prenatal care and birthweight. Although this relationship was independent of risk factors recorded on birth certificates, it is not necessarily a causal relationship. Unadjusted prematurity, neonatal and infant mortality rates did not differ between the HMO and general populations. Multivariate analyses indicated that, independent of all maternal risk factors, HMO membership was associated with an increase of 30 grams in the predicted birthweight (P less than .01), but had no effect on mortality. The data suggest that, in Portland, Oregon, pregnancy outcome for HMO members is comparable to that of the general population.

Adult↗
PubMed1998

Seeking a healthy baby: Hispanic women's views of pregnancy and prenatal care.

The goal of this study was to develop a grounded theory of pregnancy and prenatal care for a cohort of Hispanic women residing in an industrial city in the Northeast. Twenty-one women, of predominantly Puerto Rican and Dominican heritage, participated in in-depth interviews lasting 30-50 minutes in which they shared their views of pregnancies and prenatal care including cultural influences on pregnancy, social support, initiation of prenatal care, and interest and participation in perinatal education. The core category, seeking a healthy baby, emerged from the data using a constant comparison analysis method. The women enhanced their chances of achieving the goal of having a healthy baby three ways: (1) caring for self by having a positive attitude, viewing pregnancy as normal, seeking education, eating healthily, balancing activity and rest, having good habits, and initiating and continuing prenatal care; (2) receiving support from their network in the form of receiving advice, listening to problems and concerns, and providing housing, babysitting, financial aid, and transportation; and (3) accepting care from providers in Western and folk medicine.

Adolescent↗