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At least 19 recordsLinked to original sources
PubMed1985

What determines the start of prenatal care? Prenatal care, insurance, and education.

The effects of financial coverage, education, race, age, and marital status on the start of prenatal care was studied in this analysis of 85,000 live births that occurred in New York City in 1981. Log-linear models were selected for the three variables prenatal care, coverage, and education after the data had been partitioned by race, age, and marital status. An overall model for the six variables was also selected to determine the relationship between race, age, and marital status and the three principal variables named above. Late or no prenatal care was found to be associated with Medicaid and an education of less than 12 years. For the most part, the association of race and age with late or no prenatal care was mediated by coverage and education. Hispanics, blacks, and teenagers who experienced greater odds of incomplete education and Medicaid insurance experienced greater odds of late or no prenatal care.

Adolescent↗
PubMed1989

The content of prenatal care.

Prenatal care consists of patient education, evaluation of the pregnant woman for physical or historic factors requiring special care, careful assessment of gestational age, and determination of the success with which the mother and fetus(es) are tolerating the pregnancy. These elements of care during pregnancy are reviewed in turn. Additional, less tangible components of care may help explain the salutary effects of prenatal care on pregnancy outcome. The obstetric health care provider's expression of caring for the woman and her pregnancy adds to her existing social support and is a vital aspect of prenatal care.

Cost-Benefit Analysis↗
PubMedDate not supplied

CenteringPregnancy and the current state of prenatal care.

Prenatal care is often credited with improving pregnancy outcomes. Yet rates of low birthweight (LBW) and prematurity have risen in recent decades, calling into question the efficacy of traditional prenatal routines. Proposals have included broadening the objectives of prenatal care beyond prevention of LBW and enriching care to provide education and support for pregnant women. CenteringPregnancy, an innovative model of prenatal care that integrates extensive health education and group support with the standard prenatal exam, incorporates many of these elements. Impediments to wider implementation of CenteringPregnancy are explored, as well as proposals for addressing these challenges.

Female↗
PubMed1987

Accessibility, quality of care and prenatal care use in the Philippines.

The patterns and determinants of prenatal care are examined through the use of a randomly selected sample of 3000 rural and urban women who were studied prospectively during pregnancy and at three or four days postpartum. A large number of policy factors were found to influence the choice of most frequently used type of traditional, modern public or modern private prenatal care and the number of visits to each type of care, but few affected the first month of visit. The quality of care provided, accessibility to this care, and insurance available to the mother all had important effects on prenatal patterns. Large differences exist in the set of feasible policy options for improving prenatal care in urban and rural areas.

Female↗
PubMed1997

Accuracy of birth certificate data regarding the amount, timing, and adequacy of prenatal care using prenatal clinic medical records as referents.

This study compared birth certificate data on the amount, timing, and adequacy of prenatal care with the same data abstracted from the prenatal clinic records of 2,032 women who attended a health department prenatal clinic in northeast Georgia from 1980 to 1988. Overall accuracy was poor. Only 14.3% (n = 291) of the records completely agreed on the total number of visits, while approximately 36% (n = 738) and 53% (n = 1,081) agreed within one visit and two visits, respectively. Complete agreement for month and trimester prenatal care began was 31.1% (n = 632) and 50.6% (n = 1,202), respectively. Because of the small geographic region included in the current study, the generalizability of these findings to other populations may be limited.

Adult↗
PubMed1975

Practical prenatal care. I. Initial prenatal care.

Most factors which place the mother or fetus at risk are present at the time of the initial prenatal visit or develop during the pregnancy and before admission to the hospital. As many as 40 per cent of all high risk patients may be detected at the initial prenatal visit.

Adult↗
PubMedDate not supplied

Revolutionizing prenatal care: new evidence-based prenatal care delivery models.

Much of prenatal care is based on tradition and expert opinion rather than on sound scientific evidence. With the increased emphasis on providing evidence-based prenatal care, new research-based models are emerging. This article describes two new models of prenatal care delivery and the evidence supporting them. A model of reduced-frequency prenatal visits is adapted from the U.S. Department of Health and Human Services (HHS) Expert Panel on Prenatal Care (1989) recommendations that healthy, pregnant women who are at low risk for pregnancy complications may attend fewer visits without negative consequences. Another emerging model of group prenatal care, CenteringPregnancy, integrates group support with prenatal care. It is important that healthcare providers are aware of these models in order to offer the highest quality, evidence-based care to pregnant women.

Appointments and Schedules↗
PubMed2005

Evidence-based prenatal care: Part I. General prenatal care and counseling issues.

Effective prenatal care should integrate the best available evidence into a model of shared decision making. Pregnant women should be counseled about the risks of smoking and alcohol and drug use. Structured educational programs to promote breastfeeding are effective. Routine fetal heart auscultation, urinalysis, and assessment of maternal weight, blood pressure, and fundal height generally are recommended, although the evidence for these interventions is variable. Women should be offered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Genetic counseling and testing should be offered to couples with a family history of genetic disorders, a previously affected fetus or child, or a history of recurrent miscarriage. All women should be offered prenatal serum marker screening for neural tube defects and aneuploidy. Women at increased risk for aneuploidy should be offered amniocentesis or chorionic villus sampling. Counseling about the limitations and risks of these tests, as well as their psychologic implications, is necessary. Folic acid supplementation beginning in the preconception period reduces the incidence of neural tube defects. There is limited evidence that routine use of other dietary supplements may improve outcomes for the mother and infant.

Blood Grouping and Crossmatching↗
PubMed1999

Growth of infants prenatally exposed to cocaine/crack: comparison of a prenatal care and a no prenatal care sample.

OBJECTIVE: It has not been possible to draw firm conclusions about the effects of prenatal cocaine exposure because of methodologic problems involved in the conduct of this research. This study, designed to overcome some of these methodologic problems, is a prospective, longitudinal investigation of the effects of prenatal cocaine/crack exposure on neonatal growth in two samples, one with and one without prenatal care (PC). METHODS: Women in the PC sample (n = 295) were interviewed at the end of each trimester about their use of cocaine, crack, alcohol, tobacco, marijuana, and other drugs. Women in the no prenatal care (NPC) sample (n = 98) were interviewed at delivery about their drug use during each trimester of pregnancy. In both samples, information was also obtained about sociodemographic, lifestyle, psychologic, and social support characteristics. Both samples consisted of women who were predominantly low income, single, and high school educated. Of the women, 48% in the PC sample were black; 81% in the NPC sample were black. Infants were examined during the postpartum hospital stay by project nurses who were blind to maternal substance use status. RESULTS: Women in both samples who used cocaine/crack during pregnancy were older, had lower family incomes, and used more alcohol than did women who did not use cocaine/crack during pregnancy. In addition, women in the NPC sample were more likely to be black, less educated, gained less weight during pregnancy, and used more alcohol than did women in the PC sample, regardless of cocaine use. In both samples, cocaine/crack use during early pregnancy predicted reduced gestational age, birth weight, length, and head circumference, after controlling for the significant covariates of cocaine use. In a comparison of the samples, the offspring of the NPC/cocaine group were significantly smaller than were the offspring of the PC/no cocaine group, whereas the offspring of the PC/cocaine and NPC/cocaine groups did not differ. CONCLUSIONS: These results indicate that exposure to cocaine/crack during early pregnancy decreases the intrauterine growth of exposed offspring in women with and without PC. Each of the growth parameters was affected indicating symmetric growth retardation. The adequacy of PC was not a significant factor in determining the difference between cocaine-exposed and nonexposed infants. These samples are being followed throughout childhood to determine whether there are long-term effects of prenatal cocaine/crack exposure on growth.

Birth Weight↗
PubMed2000

[Criteria for choosing health care facilities for prenatal care in Pelotas, RS, Brazil].

OBJECTIVE: To describe the prenatal care delivered to a representative sample of mothers, identifying the health care facility they attended and to explore the reasons that led them to choose that specific health facility. METHOD: A cross-sectional study was conducted at four maternity hospitals in Pelotas, in Southern Brazil, from March to April 1997. A total of 401 mothers were interviewed at the hospital, immediately after delivery. RESULTS: The majority of mothers (51%) were followed up at a primary health care facility (PHCF). The main reported reason for choosing a PHCF was its geographic accessibility (46.8%). For 85% of the mothers, the nearest health service was a PHCF. However, 52.2% of them did not attend the consultations at this setting mainly because of a supposed low quality care (37.4%). Except for immunization with tetanus toxoids, all other usual prenatal care procedures recommended by the local health ministry, including promotion of breastfeeding, were performed less frequently at the PHCF than in other health care settings. CONCLUSION: Given the high coverage of the public prenatal care program, efforts should be made to improve the quality of care delivered to pregnant women, mainly by encouraging health professionals, especially doctors, to follow the established guidelines.

Adolescent↗
PubMed1994

An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index.

OBJECTIVES: The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. METHODS: Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. RESULTS: The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. CONCLUSIONS: The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.

Algorithms↗
PubMed1996

The interactive effects of race and ethnicity and mother's residence on the adequacy of prenatal care.

Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal care use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, nonmetropolitan residence, poverty, low level of education, and no insurance were more strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.

Black or African American↗
PubMedDate not supplied

Improving access to and use of prenatal care.

Inadequate prenatal care is one of the most perplexing problems in obstetrics. Many women do not seek prenatal care early, and some obtain no prenatal care. The history of prenatal care, the impact of inadequate prenatal care, and the many factors involved in access to and use of prenatal care are discussed. Nursing implications aimed at exploring ways of reducing these factors are examined.

Health Services Accessibility↗
PubMedDate not supplied

Heterogeneity between women who received prenatal care in the third trimester and those who received no prenatal care.

OBJECTIVE: To determine whether women who received prenatal care in the third trimester differed from those who received no prenatal care. METHODS: We analyzed US birth certificates from 1990 through 1992, computing the distribution of live births for women who received prenatal care in the third trimester and for those who received no prenatal care according to eight demographic and pregnancy-related characteristics (age, race, marital status, residence, country of birth, education, interbirth interval, and parity). We used the Cochran-Mantel-Haenszel statistic to test the significance of the differences between the distributions for each characteristic, adjusting simultaneously for the other seven characteristics. RESULTS: Women who received no prenatal care differed from women who received prenatal care in the third trimester for each of the demographic and pregnancy-related characteristics we examined. Among black and unmarried women, the two categories of prenatal care differed by more than 10%. CONCLUSIONS: The characteristics of women who received no prenatal care and those of women who received prenatal care in the third trimester were heterogeneous. Strategies to promote earlier prenatal care should be specific and sensitive to women at risk for each category of late entry to prenatal care.

Adolescent↗
PubMed1998

The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices.

CONTEXT: Two measures traditionally used to examine adequacy of prenatal care indicate that prenatal care utilization remained unchanged through the 1980s and only began to rise slightly in the 1990s. In recent years, new measures have been developed that include a category for women who receive more than the recommended amount of care (intensive utilization). OBJECTIVE: To compare the older and newer indices in the monitoring of prenatal care trends in the United States from 1981 to 1995, for the overall population and for selected subpopulations. Second, to examine factors associated with receiving intensive utilization. DESIGN: Cross-sectional and trend analysis of national birth records. SETTING: The United States. SUBJECTS: All live births between 1981 and 1995 (N=54 million). MAIN OUTCOME MEASURES: Trends in prenatal care utilization, according to 4 indices (the older indices: the Institute of Medicine Index and the trimester that care began, and the newer indices: the R-GINDEX and the Adequacy of Prenatal Care Utilization Index). Multiple logistic regression was used to assess the risk of intensive prenatal care use in 1981 and 1995. RESULTS: The newer indices showed a steadily increasing trend toward more prenatal care use throughout the study period (R-GINDEX, intensive or adequate use, 32.7% in 1981 to 47.1 % in 1995; the Adequacy of Prenatal Care Utilization Index, intensive use, 18.4% in 1981 to 28.8% in 1995), especially for intensive utilization. Women having a multiple birth were much more likely to have had intensive utilization in 1995 compared with 1981 (R-GINDEX, 22.8% vs 8.5%). Teenagers were more likely to begin care later than adults, but similar proportions of teens and adults had intensive utilization. Intensive use among low-risk women also increased steadily each year. Factors associated with a greater likelihood of receiving intensive use in 1981 and 1995 were having a multiple birth, primiparity, being married, and maternal age of 35 years or older. CONCLUSIONS: The proportion of women who began care early and received at least the recommended number of visits increased between 1981 and 1995. This change was undetected by more traditional prenatal care indices. These increases have cost and practice implications and suggest a paradox since previous studies have shown that rates of preterm delivery and low birth weight did not improve during this time.

Adolescent↗