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PubMed1999

[Value of multinomial model in epidemiology: application to the comparison of risk factors for severely and moderately preterm births].

BACKGROUND: The multinomial logistic regression model is employed to model the relationship between an outcome variable with more than two categories and a set of covariates. This model is not widely used in epidemiology. We discuss the value of the multinomial model by comparing it with the binary logistic model, and we present a statistical comparison of odds ratios (OR) using the multinomial model. We studied the associations between obstetric history and very (< 33 weeks of amenorrhea) and moderate (33-36 weeks) preterm births. METHODS: Parameters (lnOR) of very and moderate preterm births, associated with the severity of obstetric history (none=0, moderate=1, severe=2), were estimated using two logistic binary models (moderate preterm births vs full-term births (>=37 weeks), and very preterm births vs full-term births) and one logistic multinomial model which compared very and moderate preterm births to full-term births. These analyses were performed before and after adjustment for a covariate: the country of survey. Parameters of very preterm birth and moderate preterm birth, estimated from multinomial model, were compared using Wald test. These analyses were performed using data from a large case-control survey in Europe, the EUROPOP survey; 1 675 very preterm births, 3 652 moderate preterm births and 7 965 full-term births were included. RESULTS: Crude parameters of very and moderate preterm births were similar, regardless the logistic regression model, binary or multinomial. The estimated parameters slightly differ after adjustment for the covariate, but lower variance estimates were obtained using multinomial logistic regression model. Parameters of very preterm birth associated with moderate obstetric history, B(gp)=0.5040, and severe obstetric history, B(gp)'=1.545, differ significantly from those of moderate preterm birth, B(pm)=0.4434 and B(pm)'=1.223 respectively (p < 0.001). CONCLUSION: Parameters obtained in separate logistic binary models are close to those obtained in a multinomial model. The multinomial model is useful for testing the heterogeneity of risk factors for distinct health problems.

Gestational Age↗
PubMed2003

A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants.

OBJECTIVES: To determine whether early psychosocial intervention with low birth weight term (LBW-T) infants improved cognition and behavior and to compare LBW-T with normal birth weight (NBW) infants. STUDY DESIGN: A randomized controlled trial was carried out in Kingston, Jamaica, with 140 LBW-T infants (weight<2500 g). The intervention comprised weekly home visits by paraprofessionals for the first 8 weeks of life aimed at improving maternal-child interaction. LBW-T and 94 matched NBW (weight 2500 to 4000 g) infants were recruited from the main maternity hospital. Main outcome measures were problem solving (2 means-end tests: cover and support) and 4 behavior ratings at 7 months. Analyses used were the t test for intervention effects and multiple regression to compare LBW and NBW infants. RESULTS: LBW-T intervened infants had higher scores than LBW-T control infants on the cover test (P<.05) and were more cooperative (P<.01) and happy (P<.05). LBW-T control infants had poorer scores on both the cover (P<.001) and support tests (P<.01), vocalized less (P<.02), and were less cooperative (P<.001), happy (P<.02), and active (P<.02) than NBW infants. LBW-T intervened infants had lower scores than NBW infants only on the support test (P<.05). CONCLUSIONS: Early low-cost intervention can improve cognition and behavior of LBW-T infants in developing countries.

Anthropometry↗
PubMed1999

Small fetal size: a risk factor for breech birth at term.

OBJECTIVE: To examine fetal size as a risk factor for breech birth at term. METHODS: Singleton breech or cephalic births of gestational age > or = 37 weeks in New South Wales (NSW), Australia from 1990 to 1996 were analyzed. Birthweight percentile was used as a measure of fetal size at the time of birth. Factors associated with breech birth at term were analyzed using logistic regression. RESULTS: There were 18914 singleton breech and 540164 cephalic births in the study period. The important independent predictors of breech birth at term were advancing maternal age, primiparity, female sex and small size for gestational age. Infants < 10th percentile had an adjusted odds ratio of 1.33 (95% CI 1.28-1.38) for breech birth at term compared with 25th-75th percentile infants. CONCLUSIONS: Breech birth at term was associated with smaller fetal size for gestational age. This was shown directly through an association with birthweight-for-gestational-age percentiles and indirectly through association with female sex, primiparous birth and congenital anomalies.

Adult↗
PubMed1998

[Definition of asphyxia neonatorum and incidence of neurologic and systemic complications in the full-term newborn].

PATIENTS AND METHODS: In a prospective multicentric study, 152 of 10,065 live term births had birth asphyxia, defined by the association of three indicators (fetal distress, depression at birth and metabolic acidosis). RESULTS: The incidence of birth asphyxia was 1.5% of live term births when birth asphyxia was defined by the presence of at least two indicators, and 1% of live term births when birth asphyxia was defined by the association of metabolic acidosis and another indicator. Neurological complications were observed in 66 cases (43%). The incidence of post-asphyxial encephalopathy (PAE) was 5.9/1000 of live term births (mild PAE: 3/1000; moderate PAE: 2.7/1000; severe PAE: 0.2/1000). Systemic complications were observed in 87 patients (57%). Renal injury and coagulopathy were associated with moderate or severe PAE. Respiratory complications (39%), infections (17%) and gastro-intestinal intolerance (15%) often complicated the course. Severe complications were never seen in the absence of significant metabolic acidosis at 30 minutes of life. CONCLUSION: Our study has many implications concerning the diagnosis of birth asphyxia and its complications. A terminology based on clinical observation and arterial pH evaluation is proposed in order to clarify the situation.

Acidosis↗
PubMed2003

The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997.

OBJECTIVE: The purpose of the study was to explore the associations of placenta previa with preterm delivery, growth restriction, and neonatal survival. STUDY DESIGN: A retrospective cohort study was performed of live births in the United States (1989-1991 and 1995-1997) that used the national linked birth/infant death records from 22,368,235 singleton pregnancies. The diagnosis of previa was restricted to those live births that were delivered (> or =24 weeks) by cesarean delivery. We evaluated gestational age and birth weight-specific risk of neonatal deaths (within the first 28 days) in relation to placenta previa. Fetal growth was assessed in centiles of birth weight (<3rd, 3rd-4th, 5th-9th, 10th-90th, and >90th centile), adjusted for gestational age. All analyses were adjusted for the confounding effects of the year of delivery, maternal age, gravidity, education, prenatal care, marital status, and race/ethnicity. RESULTS: Placenta previa was recorded in 2.8 per 1000 live births (n = 61,711). Neonatal mortality rate was 10.7 with previa, compared with 2.5 per 1,000 among other pregnancies (relative risk, 4.3; 95% confidence interval, 4.0,4.8). At 28 to 36 weeks, babies born to women with placenta previa weighed, on average, 210 g lower than babies born to women without placenta previa (P <.001). Compared with babies born to women without previa, the risk of death from placenta previa was lower among preterm babies (<37 weeks of gestation), with a crossover at 37 weeks where the mortality rate was higher for babies born to women with placenta previa than for babies born to women without placenta previa. This crossover also persisted in an analysis by birth weight and term births (delivered at > or =37 weeks of gestation). Mortality rates for term births were higher among babies born to women with placenta previa than among babies born women without placenta previa who were at the 10th to 90th centile (relative risk, 1.9; 95% confidence interval, 1.3, 2.8), and those at >90th centile (relative risk, 3.6; 95% confidence interval, 1.3, 9.6). Among preterm births, however, placenta previa was not associated with increased neonatal mortality by fetal growth centiles. CONCLUSION: The risk of neonatal mortality was higher for babies born to women with placenta previa than for babies born to women without placenta previa who were delivered at > or =37 weeks of gestation. Pregnancies that are diagnosed with placenta previa must be monitored carefully, especially as they approach term.

Adult↗
PubMed2004

[Analysis of pregnancy outcomes after in vitro fertilization-embryo transfer and intracytoplasmic sperm injection].

OBJECTIVE: To compare pregnancy and perinatal outcomes between in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). METHODS: A retrospective study was carried out to measure pre-clinical and clinical abortion, ectopic pregnancies, multiple gestations, birth weight, gestational age, congenital malformation and perinatal mortality in patients receiving either IVF-ET (n = 143, group 1) or ICSI (n = 173, group 2) from January 1999 to June 2001. The outcomes of singleton and twin were compared separately. RESULTS: The maternal age, infertility duration, parity and the number of transferred embryo were comparable between the two groups. There were no significant differences in abortion rate (16.1% vs 13.3%), birth rate (65.7% vs 74.6%) between IVF-ET and ICSI groups (P > 0.05). In singleton, the rates of low birth weight, small for gestational age and pre-term birth were 1.8%, 7.3%, 5.5% respectively in IVF-ET group and 6.8%, 8.1%, 14.9% respectively in ICSI group. In twin, the rates of low birth weight, small for gestational age and pre-term birth were 34.2%, 30.3%, 42.1% respectively in IVF-ET group and 42.6%, 38.0%, 46.3% respectively in ICSI group. There were no significant differences between the two groups (P > 0.05). But the rates of low birth weight, small for gestational age and pre-term birth were higher in twin than in singleton (P < 0.01). The incidence of congenital malformation was 2.2% and 1.6% in IVF-ET and ICSI group respectively (P > 0.05). CONCLUSIONS: The pregnancy and perinatal outcomes are similar between IVF-ET and ICSI groups. Twin is the main cause of low birth weight, small for gestational age and pre-term birth.

Adult↗
PubMedDate not supplied

[Ultrasound hip joint screening in newborn infants. Correlation of anamnestic risk factors and hip dysplasia].

BACKGROUND: Congenital dysplasia of the hip (CDH) is the most frequent inborn deformity of the locomotor apparatus. Hereditary, pelvic respectively breech presentation or abdominal delivery, premature as well as post-term birth and twin pregnancy are considered to be anamnestic risk factors for congenital dysplasia of the hip. The results of ultrasound hip screening from July 87 until December 94 are presented with special regard to the correlation of these risk factors and the occurrence of pathologic hips. PATIENTS: 19 different orthopaedic surgeons examined the hips of 3739 newborns (female: 1837-49.1%; male: 1902-50.9%) by ultrasound (screening). 96% of the examinations were performed within a period of 5 days after birth, in a few cases the babies were up to 19 days old. METHOD: The ultrasound examinations, the assessment of the echograms and classification into types of hip were performed according to Graf's technique. Two types of ultrasonographs were used: SL-1, Siemens--5 MHz scanner; LSC 7500, Picker--7.5 MHz scanner). All investigations were assessed retrospectively over the period of time with the help of documentation forms (data of newborn baby, case history, clinical and sonographical findings, kind of therapy and procedure) and statistically checked (program SPSS 7.5, Chi-Quadrate-Test, logistic regression). RESULTS: In 239 children (6.4%) we found hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). For the entire group we achieved the following types of hips (right/left side): Ia--214 (5.7%)/224 (6.0%); Ib--2069 (55.3%)/2008 (53.7%); IIa (> or = 55 degrees)--1318 (35.3%)/1322 (35.4%); IIa (< 55 degrees)--65 (1.7%)/74 (2.0%); IIc--45 (1.2%)/71 (1.9%); D--18 (0.5%)/30 (0.8%); IIIa--8 (0.2%)/7 (0.2%); IIIb--1 (< 0.1%)/2 (0.1%); IV--1 (< 0.1%)/1 (< 0.1%). With regard to the risk factors the distribution was as follows: hereditary--302 babies (8.1%), pelvic respectively breech presentation--149 (4%), abdominal delivery--359 (6.5%), premature birth--188 (5.0%), post-term birth--164 (4.4%), twin pregnancy--73 (2%). CONCLUSIONS: In newborn babies with cases of hip dysplasia in their family (heredity) and pelvic respectively breech presentation at birth we found a significant higher rate (p < 0.05) of hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). Also, for girls and the left hip a significant higher rate was achieved. A correlation of the other mentioned risk factors abdominal delivery, premature and post-term birth as well as twin pregnancy was not evident.

Equipment Design↗
PubMed1988

Breast cancer in relation to the occurrence and time of induced and spontaneous abortion.

The authors evaluated whether an induced or spontaneous abortion during the first six months of gestation, particularly if it occurs before the first term pregnancy, increases the risk of breast cancer. Data from a case-control study of women under 70 years of age were used: 3,200 cases of breast cancer were compared with 4,844 controls with nonmalignant nongynecologic conditions. Among both nulliparous and parous women, the risk of breast cancer was not related to the number of induced or spontaneous abortions. After allowance for all identified potential confounding factors, the estimated relative risk for nulliparous women with an induced abortion relative to those who had never been pregnant was 1.3 (95% confidence interval (CI) 0.8-2.2), and for spontaneous abortion, the corresponding estimate was 0.9 (95% CI 0.5-1.5). Among parous women, the estimated relative risks were 1.2 (95% CI 0.9-1.6) for an induced abortion and 0.9 (95% CI 0.8-1.0) for a spontaneous abortion, relative to never having had an abortion of any type. The time of the abortion had little effect: The relative risk estimates were 0.9 (95% CI 0.5-1.4) for induced abortion before the first term birth, 1.4 (95% CI 1.0-1.9) for induced abortion first occurring after the first term birth, 0.9 (95% CI 0.7-1.2) for spontaneous abortion before the first term birth, and 0.9 (95% CI 0.7-1.0) for spontaneous abortion first occurring after the first term birth. Similar results were evident for women under age 40, among whom the frequency of induced abortion was relatively high. These data suggest that the risk of breast cancer is not materially affected by abortion, regardless of whether it occurs before or after the first term birth.

Abortion, Induced↗
PubMed2005

Periodontal infections and pre-term low birth weight: a case-control study.

OBJECTIVE: Pre-term delivery of low-birth-weight infants [pre-term low birth weight (PLBW)] remains a significant public health issue and a major cause of neonatal death and long-term health problems. There is a growing consensus that infections remote from fetal-placental unit may influence PLBW infants. Recent studies have suggested that maternal periodontal disease may be an independent risk factor for PLBW. The purpose of the present study was to evaluate the possible link between periodontal infections and PLBW by means of clinical and microbiological data in post-partum women with low socioeconomic level. METHODS: Clinical periodontal recordings comprising dental plaque, bleeding on probing, probing pocket depth and gingival recession were performed (six sites/tooth) in a total number of 181 women (53 cases and 128 controls) within 3 days post-partum. Subgingival plaque samples from mesio-or disto-buccal aspect of randomly selected one first molar and one incisor tooth have been obtained by paperpoints and were analysed by checkerboard DNA-DNA hybridization with respect to 12 bacterial species. In all analyses, the individual subject was the computational unit. Thus, mean values for all clinical parameters were calculated and bacterial scores from each individual sample were averaged. Statistical methods included Student's t-test, Fisher's exact test/chi(2) test, and multiple logistic regression analysis. RESULTS: The cases have gained significantly less weight during the pregnancy than did the controls (p<0.05). There were no statistically significant differences between the cases and controls with regard to the dental and periodontal parameters and the values of clinical periodontal recordings were found to be very similar (p>0.05). Mean and median scores (bacterial loads) of Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Actinobacillus actinomycetemcomitans, and Streptococcus intermedius in the subgingival plaque sampling sites were significantly higher in the controls than in the cases (p<0.05). The occurrence rates of P. intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, Campylobacter rectus, Eikenella corrodens, Selenomonas noxia and S. intermedius were higher in the cases compared with the controls, but the differences were not statistically significant (p>0.05). According to the model created by the multiple logistic regression analysis, P. micros and C. rectus were found to significantly increase the risk of PLBW (p<0.01 and p<0.05 respectively), while P. nigrescens and A. actinomycetemcomitans decreased this risk (p<0.01). CONCLUSION: The present findings indicated that when subgingival bacteria were evaluated together, P. micros and C. rectus may have a role in increasing the risk for PLBW, although no single bacteria exhibited any relation with the risk of PLBW. Further studies are required to better clarify the possible relationship between periodontal diseases and PLBW.

Adolescent↗
PubMed2006

Risk factors for cervical insufficiency after term delivery.

OBJECTIVE: Cervical insufficiency can be unexpected in a woman with a previous term birth. Our objective was to determine what risk factors, if any, place women with a term delivery at risk for cervical insufficiency in a subsequent pregnancy. STUDY DESIGN: Demographic characteristics were collected for a cohort of women with at least 1 previous term birth followed by cervical insufficiency (subject group) and for uncomplicated multiparous women (control group). Multiparous women with cervical insufficiency (subjects; n = 49) were compared with multiparous women who were experiencing repeat term birth with no history of cervical insufficiency (control group; n = 49). RESULTS: Patients with cervical insufficiency were similar to control subjects demographically. No difference was noted in previous cervical procedures or spontaneous preterm deliveries. Multivariate logistic regression analysis identified a history of curettage (odds ratio, 4.6; 95% CI, 1.7-12.5), precipitous delivery (odds ratio, 6.8; 95% CI, 1.6-29.6), and prolonged second stage of labor (odds ratio, 24.9; 95% CI, 2.4-253) as independent predictors of cervical insufficiency. CONCLUSION: Multiparous women who experience cervical insufficiency after a term birth are more likely to have had a previous precipitous delivery, a prolonged second stage of labor, or a previous curettage compared with multiparous women who experience a repeat term birth with no cervical insufficiency.

Adult↗
PubMed1982

The bacterial colonization of the large bowel of pre-term low birth weight neonates.

The bacterial colonization of the large bowel of 11 pre-term, low birth weight neonates who were nourished by expressed breast milk was examined by culturing serial faecal samples and compared to that observed in eight breast-fed and seven formula-fed full-term neonates. Pre-term neonates were colonized by high counts of facultatively anaerobic bacteria from the first days of life while bifidobacteria colonized only six babies during the first week and appeared in only one baby before day 5. Bacteroides spp. and clostridia were isolated from seven and six pre-term babies respectively during week 1 and were first observed on day 2. The intestinal colonization of pre-term infants differed from that in full-term breast-fed infants in the high counts of facultatively anaerobic bacteria and late appearance of bifidobacteria, and from both groups of full-term infants in the early stable colonization by Bacteroides spp. It is postulated that the composition of the normal intestinal microflora of pre-term low birth weight babies contributes to their predisposition to neonatal necrotizing enterocolitis. Results are discussed in relation to the effect of infant feeding regimens on intestinal microbial populations.

Actinomycetaceae↗
PubMed1987

Circadian incidence of labor onset hour in preterm birth and chorioamnionitis.

Normal labor begins most frequently between midnight and 2 AM, presumably because of an unidentified circadian labor-activating mechanism. We used records of the Collaborative Perinatal Project to determine whether such a circadian mechanism is present with intrauterine growth retardation (IUGR) or preterm birth, and whether chorioamnionitis is associated with alternative patterns. In the absence of chorioamnionitis, both preterm births and term births with IUGR demonstrated nocturnal labor onset distributions like those of control term deliveries, which had a peak incidence at 1:45 AM and an amplitude of 35%. With chorioamnionitis, in contrast, there was a different circadian distribution of term labor onset hour, with a peak at 7:45 PM and a 32% amplitude. A similar trend was found among preterm births. These data suggest the presence of the normal nocturnal labor-activating mechanism in both growth-retarded term deliveries and a defined subset of preterm deliveries. Chorioamnionitis appears to be associated with a prominent, unidentified alternative labor-activating mechanism that is maximal in the evening.

Chorioamnionitis↗
PubMed2005

[Occurrence of preterm and term low birth weight deliveries and presence of the Sydney crease].

OBJECTIVE: To determine whether simian and Sydney creases are associated to preterm delivery or to term low birth weight. PATIENTS AND METHODS: We performed a cross-sectional study of 490 live newborns without apparent malformations from the Hospital Civil de Guadalajara Dr. Juan I. Menchaca (Guadalajara, Mexico). Patients were categorized in three groups: group I: 175 infants with preterm delivery; group II: 140 term low birth weight infants; group III: 175 at term newborns with adequate weight for gestational age. On all groups, perinatal history was registered and palm creases were studied by direct inspection and classified as normal, simian crease (single palmar flexion crease) or Sydney crease (continuation of the proximal palmar crease until the ulnar border of the palm). We used the odds ratio as an association measurement, with 95% confidence intervals. RESULTS: The simian crease frequency did not show significant differences between groups. Sydney crease frequencies on groups I, II and lll were 29.7, 34.2 and 18.2%, respectively (p = 0.0037). Sydney crease presence was associated with near to two-fold frequency to preterm birth (OR: 1.89, 95% CI: 1.11-3.23) and more than double with low birth weight (OR: 2.33, 95% Cl: 1.07-5.23). CONCLUSIONS: Sydney crease was associated with occurrence of the preterm and term low birth weight deliveries.

Apgar Score↗
PubMed1993

Variation in birth timing and location of the neonatal line in human enamel.

The location of the neonatal line in 173 primary teeth from 43 children was investigated and shown to differ significantly among pre-term, term, and post-term births. Approximately 75% of the neonatal lines that lie beyond 2SD of the mean location of the line in term births are from children born outside of 38 to 42 weeks gestation. The duration of pregnancy accounts for about 36% of the variation in location of the neonatal line in non-term births. Based on the small proportion of non-term births whose neonatal line is located beyond 2SD of the mean location of the neonatal line in term births, it is estimated that this technique will provide individualizing information in about 3% of immature skeletonized remains in a forensic context. The relative timing of pre- and postnatal pathological striae in the enamel of primary teeth can be evaluated in terms of the variation, documented here, in the location of the neonatal line due to individual and birth timing differences. Determination of the timing of pathological enamel striae will aid in the identification of both children and adults for whom histological examination of enamel is undertaken.

Child↗
PubMed2006

The relationship between maternal periodontitis, adverse pregnancy outcome and miscarriage in never smokers.

BACKGROUND: It has been postulated that associations between periodontal disease and systemic conditions may be because of the confounding effects of smoking. In addition, studies of this type rarely investigate the adverse pregnancy outcome of miscarriage. AIM: The aim of this prospective study was to investigate a relationship between periodontal disease in pregnancy and subsequent adverse pregnancy outcomes in a population of never smokers. MATERIALS AND METHODS: Pregnant women were recruited at 12 weeks gestation. Demographic, behavioural and medical data were collected. A periodontal examination was performed and data on each subjects' pregnancy outcome were collected. RESULTS: A total of 1793 women reported never previously smoking. Of these, 7.3% had a pre-term birth and 0.9% a late miscarriage. As expected in this population, we found no associations between poorer periodontal health and either pre-term birth or low birth weight (LBW). In contrast, the subjects who experienced a late miscarriage had a higher mean probing depth at mesial sites compared with the subjects that gave birth at term (2.69 mm versus 2.41 mm, p=0.006). CONCLUSIONS: There was an association between some measures of periodontal disease and late miscarriage; however, there was no association between periodontitis and pre-term birth or LBW in this population.

Abortion, Spontaneous↗
PubMed1998

Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil.

OBJECTIVE: To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population. DESIGN: A prospective double-blind, part-randomised efficacy trial. SETTING: A low-income population in Pernambuco, northeast Brazil, where the economy is largely dependent on sugar-cane production, and where over 90% of deliveries occur in health facilities. SUBJECTS: During a 20-month period, all singleton, term infants weighing 1500-2499 g born to families of low income ( < US $280/month) were enrolled at birth (n = 205). At 6 and 12-months, the numbers tested were 163 and 138 respectively. INTERVENTION: Infants born from January 1993-January 1994 were randomly assigned to receive daily, except Sundays, a placebo (n = 66) or 1 mg zinc (n = 68). Those born February-August 1994 were given 5 mg zinc (n = 71). Supplementation was for eight weeks, starting at birth. Field workers visited each infant at home to administer the supplement. RESULTS: At 6 and 12-months, mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found. At 12-months, behaviour was also assessed on 5 ratings. Ratings were highest in infants given 5 mg zinc (P = 0.042). CONCLUSIONS: Zinc supplementation (5 mg/d) for eight weeks may reverse some of the poor behaviours, particularly responsiveness, exhibited by low birth weight infants. No amelioration of their mental and psychomotor deficits was found.

Behavior↗
PubMed2005

Managed care and infant health: an evaluation of Medicaid in the US.

In this study, we examine the effects of Medicaid managed care (MMC) on prenatal care utilization, infant birth weight, pre-term birth, and use of cesarean section in the United States. We obtain separate estimates of the effect of primary care case management managed care programs and health maintenance organization managed care plans on these outcomes. The results suggest the following: among white, non-Hispanic women, MMC was associated with a 2 percent decrease in the number of prenatal care visits and a 3-5 percent increase the incidence of inadequate prenatal care; MMC was associated with a significant increase in the incidence pre-term birth for non-Hispanic white women, but that this association does not appear to be causal; and MMC had no association with the incidence of cesarean section.

Birth Weight↗