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PubMed1993

The association between prenatal care and birth weight among women exposed to cocaine in New York City.

OBJECTIVES: Although the association between antenatal cocaine use and adverse birth outcomes has been well documented, relatively little is known about interventions that may ameliorate these consequences. We therefore examined the relationship between prenatal care and birth weight among a population of prenatal cocaine users. DESIGN: Population-based retrospective analysis. PATIENTS: All single-gestation live births to white non-Hispanic, black non-Hispanic, and Hispanic residents of New York City who gave birth between 1988 and 1990 with a positive indication for cocaine recorded on birth certificates (N = 7923). MAIN OUTCOME MEASURES: We contrasted mean birth weight and rates of low birth weight (< 2500 g) among cocaine users with one to three prenatal care visits, four or more visits, and unknown numbers of visits with users who reported no prenatal care. We used ordinary least squares and logistic regression to control for age, parity, smoking, alcohol, other drugs, weight gain, prepregnancy weight, employment, marital status, participation in the Supplemental Food Program for Women, Infants and Children, and method of finance. MAIN RESULTS: Adjusted odds ratios of low birth weight for cocaine users with four prenatal care visits or more as compared with those who had none were 0.51 for blacks (95% confidence interval [CI], 0.44 to 0.59), 0.39 for whites (95% CI, 0.23 to 0.66), and 0.37 for Hispanics (95% CI, 0.28 to 0.48). Adjusted mean birth weight differences between users with four visits or more and those with none were 262 g for blacks (P < .001), 247 g for whites (P < .001), and 317 g for Hispanics (P < .001). CONCLUSIONS: The receipt of prenatal care among cocaine users is associated with significant improvements in birth weight. Enrollment of cocaine users in prenatal care may be an effective start to a more comprehensive approach to this problem.

Adult↗
PubMed2005

Welfare and immigration reform and use of prenatal care among women of Mexican ethnicity in San Diego, California.

Foreign-born women and, in particular, Hispanic foreign-born women, are less likely to have insurance, are less likely to have insurance that covers prenatal care, and are less likely to utilize prenatal care compared with US-born Hispanic women. Significant concern has been raised regarding the ability of immigrant women to access prenatal care services because of severe restrictions imposed on immigrants' eligibility for Medicaid-funded services following the passage in 1996 of the federal Personal Responsibility and Work Opportunity Reform Act (PRWORA) and the Illegal Immigration Reform and Immigrant Responsibility Act (IIRAIRA). We conducted an interview-based study of prenatal care utilization with women of Mexican ethnicity and diverse immigration statuses in San Diego County, California. Our findings indicate that, despite increased levels of fear associated with recent immigration and with undocumented status, there were no statistically significant differences across immigration statuses in length of time to receipt of medical care for gynecological events and for prenatal care.

Acculturation↗
PubMed2006

[Prenatal care in an university hospital: evaluating the process].

The objective of this study was to evaluate the prenatal care process referring to the Prenatal Assistance to Low Risk Pregnant Women Program of the University Hospital of Maringá, Paraná State, Brazil. It was made a selection of quality criteria which evaluate the precocity in the process and the adequacy in the number of consultation during prenatal period, measured by the Humanization Program of Prenatal and Birth of the Health Ministry and the adequacy on the use of the prenatal care. The study showed that 44.5% of pregnant women started late the prenatal care suggest of the low offer and search to better quality care, which is manifested by spontaneous transference of pregnant women to other services to the program. The prenatal consultations were confirmed and the results showed a mean of 9.8 consultations per pregnant woman--higher than the recommended national parameters. The indicators used and developed to the evaluation of process still present some obstacles to the organizational access and need to define strategies which guarantee this fundamental policy of the Brazilian Unified Health System.

Brazil↗
PubMed1998

Prenatal care in cocaine-exposed pregnancies.

OBJECTIVE: To examine the effect of prenatal care with and without drug rehabilitation on perinatal outcome in cocaine-using women. METHODS: Cocaine-exposed pregnancies of 905 human immunodeficiency virus (HIV)-negative women were frequency matched (ratio 6:1) and compared with 150 nonusers. Cocaine subgroups consisted of 278 women who received prenatal care and drug rehabilitation ("comprehensive care"), 206 women who received prenatal care only, and 421 who received neither. Maternal and fetal complications, drug screening, and attendance were recorded. Pregnancy rates and HIV seroconversion were determined over the year following delivery. RESULTS: The groups were similar in age, race, education and poverty level. Linear trends of increasing incidence of maternal complications were seen across the four groups. Comparing nonusers with cocaine users, the odds ratios, with 95% confidence intervals were: 28.0 (4.2, 103.2) for both anemia and weight under 100 lb; 2.4 (1.8, 5.0) for urinary tract infections; 15 (4.6, 36.1) for syphilis; and 11.2 (4.0, 35.8) for other sexually transmitted diseases. Perinatal outcome measures were similar for nonusers and "comprehensive care" groups but significantly worse for the other two groups. Four maternal deaths and two myocardial infarctions occurred with no care. Positive toxicology at delivery was 1.5 and 4.3 times more likely for the two groups without drug treatment, than for "comprehensive care." Congenital anomalies and HIV seroconversion increased in cocaine users. Repeat pregnancy was less likely and more often drug free with "comprehensive care." CONCLUSION: "Comprehensive care" of the cocaine-using gravida increases the likelihood of carrying to term, having fewer complications, being drug free at delivery, and having fewer exposed repeat pregnancies.

Adult↗
PubMed1992

Maternal demographic, situational and psychosocial factors and their relationship to enrollment in prenatal care: a review of the literature.

Whether or not a woman enrolls in prenatal care in a timely fashion is a major predictor of pregnancy outcome. In this review, we consider maternal demographic, situational and psychosocial factors which have been studied with relation to enrollment in prenatal care. Paying increased attention to some situational barriers such as problems with child care or transportation, and a number of psychosocial factors such as unplanned pregnancy and negative feelings about medical care, holds promise in achieving improved utilization of prenatal care.

Adolescent↗
PubMed2000

Prenatal care among Puerto Ricans on the United States mainland.

Recent public health initiatives in the USA identify the improvement of maternal and infant health outcomes among ethnic minorities as a national priority. Prenatal care is emphasized in these initiatives as a crucial intervention for reducing the risks of adverse outcomes. We investigate the barriers to prenatal care and the adequacy of prenatal care among mainland Puerto Ricans using data from a follow-back survey of a representative sample of mothers. The results show that barriers to prenatal care and the adequacy of prenatal care cannot be reduced solely to financial problems or problems associated with migration. Rather, attention to the social and the psychological circumstances surrounding the pregnancy (e.g. pregnancy wantedness) is required.

Female↗
PubMed1990

Prenatal care in northwestern Wisconsin.

The purposes of this study were to identify the components of prenatal care given by family practice physicians and obstetricians in a rural area and determine whether they were in agreement with standards of care advanced by the American College of Obstetricians and Gynecologists (ACOG). We surveyed 76 physicians (family physicians with and without residency training and obstetricians) and identified 40 components of regular prenatal care; they were consistent with 94% of the ACOG recommendations. Few differences were found in prenatal care practices by type of family practice training. Although the number of obstetricians was small, these specialists appeared more likely to agree with ACOG guidelines. Risk assessment instruments were not routinely used by most physicians, and the services of public health nurses were not generally recommended as part of prenatal care. The findings have implications for continuing medical education programs.

Female↗
PubMedDate not supplied

Satisfaction and adequacy of prenatal care utilization among rural low-income women.

This study was designed to describe adequacy and satisfaction with prenatal care in a group of rural low-income women (n = 60) and to determine whether either was correlated with birth outcomes. Despite less than adequate prenatal care in 50% of the women, they were satisfied with their care, and outcomes for infants were good. When compared with women who received adequate prenatal care, there were no differences between the two groups. Tailoring prenatal care to individual needs, including care provided by certified nurse midwives with fewer prenatal visits, could be cost-effective without sacrificing quality. It is time to reexamine the recommended prenatal visit structure and care delivery in this country.

Adolescent↗
PubMedDate not supplied

Prenatal care of African American women in selected USA urban and rural cultural contexts.

The purpose of this ethnonursing research was to systematically discover, describe, and analyze the beliefs, practices, and values of African American women related to prenatal care. The domain of inquiry was prenatal care of African American women within their familiar cultural contexts. The study was conceptualized within Leininger's Theory of Culture Care Diversity and Universality which enabled the researcher to study professional and generic care as influenced by the worldview, social structural factors, cultural values and beliefs, ethnohistory, and environmental context. The goal of the study was to discover knowledge that could be used by health professionals to provide culturally congruent prenatal care that would increase the health and well being of the people. The rationale for the study was based on studies that showed the lack of prenatal care in the African American cultural group leads to low birth weights and high infant mortality rates. Four major themes that focused on the domain of inquiry were identified: 1) Cultural care meant protection, presence, and sharing; 2) social structural factors that greatly influenced the health and well being were spirituality, kinship, and economics; 3) professional prenatal care was seen by the women as necessary and essential but there was distrust of noncaring professionals, and barriers to such care; and 4) folk health beliefs, practices, and indigenous health care providers were widely used by women in the African American community.

Adolescent↗
PubMed1997

Adequacy of prenatal care utilization, maternal ethnicity, and infant birthweight in Chicago.

This study examines the extent to which the Adequacy of Prenatal Care Utilization Index explains the racial disparity in infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and non-Latino white singleton infants born in Chicago, Illinois between 1982 and 1983. This older cohort was chosen to avoid the confounding effect of cocaine associated with its increased local availability after 1985. The adequacy of prenatal care utilization varied by race and place of residence. However, in moderate-income areas (median family annual income of $20,001 to $30,000), the African-American birthweight disadvantage persisted among infants born to mothers who received adequate and adequate-plus prenatal care. Similarly, although race-specific term (gestational age > 37 weeks) low birthweight rates declined as prenatal care usage rose, the position of African Americans relative to Mexican Americans and whites was essentially unchanged. These findings indicate that maternal race or some factor closely related to it affects pregnancy outcome regardless of the adequacy of prenatal care utilization.

Black or African American↗
PubMed1987

Barriers to receiving adequate prenatal care.

One hundred eleven postpartum patients who received varying amounts of prenatal care (no care, inadequate care, intermediate care, and adequate care) were assessed for demographic, medical and sociocultural factors by interview and review of the medical chart. Six sociocultural factors identified by stepwise multiple regression contributed to 49% of the variance for amount of prenatal care: amount of insurance, attitudes toward health professionals, delays in suspecting pregnancy, delay in telling others about the pregnancy, perception of the importance of prenatal care, and initial attitudes about being pregnant. Results are discussed in terms of developing outreach programs altered to the patient's needs and life-styles.

Adult↗
PubMed1994

Physicians' expectations for quality nutrition expertise and service in prenatal care.

OBJECTIVES: To identify physicians' needs and expectations related to quality nutrition services in prenatal care; to rank service characteristics by importance in making nutrition referral decisions; and to identify nutrition services physicians would likely add to their practice. DESIGN: We used a market research survey based on the quality service management model. SETTING: We selected prenatal care as the setting because diet plays an important role in the health of the mother and the infant; specific recommendations exist for physicians to provide for nutrition assessment and counseling during pregnancy; and dietitians are not uniformly represented and used in obstetrics practices. SUBJECTS: The survey population consisted of all members of a state obstetrics and gynecology society (N = 352). A return rate of 37% was achieved. ANALYSIS: Data were analyzed using descriptive statistics and qualitative analytic methods. RESULTS: Responses from 130 physicians revealed an expectation that dietitians working in prenatal care must have expertise in prenatal nutrition and skillfully work with patients to achieve compliance with individualized care plans. To be judged excellent, physicians indicated that nutrition care would have to produce desired outcomes in patients. Good communication, documentation, and availability of the dietitian were also important. Financial issues were not of great concern to the respondents. APPLICATION: The findings from this study help pinpoint opportunities for dietitians to develop and strengthen relationships with physician-customers for the provision of quality nutrition service in prenatal care. Important characteristics of quality nutrition service include timely and effective counseling followed by conscientious documentation and feedback to physician.

Adult↗
PubMed1985

Prenatal care and the low birth weight infant.

In this study the authors assessed human and economic consequences of low birth weight linked to the lack of prenatal care for indigent women. Low birth weight infants were defined as those who weighed between 860 and 2220 g, corresponding to the 50th percentiles at 26 and 34 weeks' gestation. Women seeking prenatal care had a significantly decreased incidence of low birth weight infants compared with those without such care. Concomitantly, low birth weight infants born to women with prenatal care had significantly better perinatal survival as well as less frequent respiratory distress and intraventricular hemorrhage. Because of these factors, infants born to clinic mothers used fewer neonatal intensive care days and had shorter hospitalizations. Hospital costs were reviewed for 175 surviving infants and failure to obtain prenatal care was associated with a 50% increase in costs for each infant. The frequencies of the most common pregnancy complications in women with and without prenatal care, coupled with corresponding obstetric interventions, suggest that such care facilitates identification and management of women at risk for delivery of low birth weight infants. The authors conclude that there are important human and economic advantages of antenatal care for indigent women.

Adolescent↗
PubMed1995

Tetanus immunization and prenatal care in developing countries.

OBJECTIVE: We sought to estimate the proportion of women immunized against tetanus while attending prenatal care in the developing countries. METHOD: We computed the ratio of the percentage of births to women immunized against tetanus to the percentage of births to women with prenatal care (TP ratio). A TP ratio is lower than 100% if not every woman attending prenatal care is immunized. We used 1986-1992 Demographic and Health Surveys data from 38 countries. RESULTS: The mean TP ratios were 86% in Africa (n = 23), 79% in Asia (n = 6) and 60% in Latin American and the Caribbean (n = 9). The TP ratio was lower than 75% in 15 countries. Of these, four had a TP ratio lower than 50%. CONCLUSION: In many countries the number of pregnant women immunized against tetanus is lower than the number of women attending prenatal care, suggesting that prenatal services are missing opportunities to immunize attending women.

Developing Countries↗
PubMedDate not supplied

Obstacles to prenatal care following implementation of a community-based program to reduce financial barriers.

A study of women who gave birth in a rural Oregon county during 1988-1990 found that despite the establishment of a program to provide prenatal care to low-income women who could not afford it, the most common reasons cited for inadequate prenatal care were financial obstacles. All 13 financial, personal and organizational barriers studied were reported more frequently by the 236 women who received inadequate or no care than by the 246 women who received adequate care. Among the reasons most frequently cited by women who received inadequate care were difficulty paying for prenatal care (70%), difficulty with medical insurance (55%), ambivalence or fear about the pregnancy (46%) and transportation problems (42%). In a logistic regression analysis that controlled for social and demographic characteristics, six barriers were significant predictors of inadequate care: The odds of receiving inadequate care were 7.9 among women who had a poor understanding of or attached a low value to prenatal care compared with those who did not cite this barrier, 3.4 among those who cited financial difficulties, 3.4 among those who said they had difficulty scheduling appointments, 3.0 among those who suffered excessive physical or psychological stress, 2.7 among those who said they did not know where to go for prenatal care, and 1.8 among those who felt ambivalence or fear regarding the pregnancy.

Adolescent↗
PubMed1999

Health insurance, the quantity and quality of prenatal care, and infant health.

This paper presents a comprehensive analysis of the relationship between Medicaid, infant health, and the quantity and quality of prenatal care using data from the 1988 National Maternal and Infant Health Survey (NMIHS). This integrated approach provides a more complete picture of the effect of Medicaid and its avenues of influence, and is less likely to lead to spurious findings. The results indicate that there was no statistically significant relationship between insurance status and birth weight holding constant other observed characteristics, although there was some evidence that uninsured women and Medicaid recipients received less prenatal care than did privately insured women. Differences in prenatal care utilization, however, were small. In addition, there was no evidence that uninsured women or Medicaid recipients received lower-quality prenatal care than privately insured women did even in a period prior to implementation of state programs aimed at ensuring high-quality care. The results of this paper raise questions about the efficacy of the current public health response to poor infant health that relies on expanding insurance coverage and enriched prenatal care programs.

Birth Weight↗
PubMed2006

Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?

OBJECTIVES: To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy. METHODS: The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage. RESULTS: Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively. CONCLUSIONS: Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.

Adult↗
PubMedDate not supplied

[Impact of the prenatal care in the neonatal morbidity and mortality].

OBJECTIVE: To analyze the prenatal care impact in the neonatal morbidity and mortality. MATERIALS AND METHODS: Case-control cohort-nested study, among hospitalized and healthy newborns. The variables studied were: prenatal care, neonatal morbidity (respiratory distress syndrome, prematurity, low weight at birth, congenital malformations and asphyxia) and mortality, as well as mother's age, weight, height, gestation, and level of education. The statistical analysis was made through percentage, rates and standard deviation, odds ratio and chi2. RESULTS: We analyzed 407 mother and newborn files divided in 2 groups: 118 hospitalized newborns (cases) and 289 healthy newborns (controls). Respiratory distress syndrome (OR 3.559, IC 1.865-6.794), low weight at birth (OR 3.504, IC 1.861-6.597) and prematurity (OR 5.044, IC 2.624-9.698) were significant, but not asphyxia. Other variables were similar in both mother groups. CONCLUSION: Prenatal care produces low incidence of respiratory distress, low weight at birth and prematurity in the newborn. Neonatal mortality rate (6%), was lower than in other studies.

Case-Control Studies↗