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Am J Perinatol 2012; 29(10): 787-794
DOI: 10.1055/s-0032-1316439
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inadequate Prenatal Care Utilization and Risks of Infant Mortality and Poor Birth Outcome: A Retrospective Analysis of 28,729,765 U.S. Deliveries over 8 Years

Sarah Partridge
1   Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
,
Jacques Balayla
1   Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
,
Christina A. Holcroft
1   Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
,
Haim A. Abenhaim
1   Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

27 October 2011

29 February 2012

Publication Date:
26 July 2012 (online)

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Abstract

Objective To evaluate the association between adequacy of prenatal care utilization and risk of fetal and neonatal mortality and adverse outcomes.

Methods We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all deliveries in the United States between 1995 and 2002. Inclusion criteria were singleton births ≥22 weeks of gestation with no known congenital malformation. Inadequate prenatal care was defined according to the Adequacy of Prenatal Care Utilization Index, and its effect on fetal and neonatal death was estimated using unconditional logistic regression analysis adjusting for maternal age, race, education, and other confounding variables.

Results During our 8-year study period, 32,206,417 births occurred, 28,729,765 (89.2%) of which met inclusion criteria. Inadequate prenatal care utilization occurred in 11.2% of expectant mothers, more commonly among women ≤20 years, black non-Hispanic and Hispanic women, and those without high school education. Relative to adequate care, inadequate care was associated with increased risk of prematurity 3.75 (3.73 to 3.77), stillbirth 1.94 (1.89 to 1.99), early neonatal dearth 2.03 (1.97 to 2.09), late neonatal death 1.67 (1.59 to 1.76), and infant death 1.79 (1.76 to 1.82).

Conclusion Risk of prematurity, stillbirth, early and late neonatal death, and infant death increased linearly with decreasing care. Given the population effect of this association, public health initiatives should target program expansion to ensure timely and adequate access, particularly for women ≤20 years, Black non-Hispanic and Hispanic women, and those without high school education.

Keywords

prenatal care - risk factors - pregnancy outcome - infant mortality - population characteristics
 

  • References

  • 1 Manual of Standards in Obstetric-Gynecologic Practice. 2nd ed. Vol. III. Chicago: American College of Obstetricians and Gynecologists; 1965
    Search in Google Scholar
  • 2 Fiscella K. Does prenatal care improve birth outcomes? A critical review. Obstet Gynecol 1995; 85: 468-479
    CrossrefPubMedSearch in Google Scholar
  • 3 Lu MC, Tache V, Alexander GR, Kotelchuck M, Halfon N. Preventing low birth weight: is prenatal care the answer?. J Matern Fetal Neonatal Med 2003; 13: 362-380
    CrossrefPubMedSearch in Google Scholar
  • 4 Alexander GR, Cornely DA. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prev Med 1987; 3: 243-253
    PubMedSearch in Google Scholar
  • 5 Krueger PM, Scholl TO. Adequacy of prenatal care and pregnancy outcome. J Am Osteopath Assoc 2000; 100: 485-492
    PubMedSearch in Google Scholar
  • 6 Debiec KE, Paul KJ, Mitchell CM, Hitti JE. Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol 2010; 203: 122 , e1–e6
    PubMedSearch in Google Scholar
  • 7 Heaman MI, Newburn-Cook CV, Green CG, Elliott LJ, Helewa ME. Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices. BMC Pregnancy Childbirth 2008; 8: 15
    CrossrefPubMedSearch in Google Scholar
  • 8 Poland ML, Ager JW, Sokol RJ. Prenatal care: a path (not taken) to improved perinatal outcome. J Perinat Med 1991; 19: 427-433
    CrossrefPubMedSearch in Google Scholar
  • 9 Showstack JA, Budetti PP, Minkler D. Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation. Am J Public Health 1984; 74: 1003-1008
    CrossrefPubMedSearch in Google Scholar
  • 10 Villar J, Ba'aqeel H, Piaggio G , et al; WHO Antenatal Care Trial Research Group. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001; 357: 1551-1564
    CrossrefPubMedSearch in Google Scholar
  • 11 Carroli G, Villar J, Piaggio G , et al; WHO Antenatal Care Trial Research Group. WHO systematic review of randomised controlled trials of routine antenatal care. Lancet 2001; 357: 1565-1570
    CrossrefPubMedSearch in Google Scholar
  • 12 Singh GK, Yu SM. Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010. Am J Public Health 1995; 85: 957-964
    CrossrefPubMedSearch in Google Scholar
  • 13 Kotelchuck M. The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight. Am J Public Health 1994; 84: 1486-1489
    CrossrefPubMedSearch in Google Scholar
  • 14 Kotelchuck M. Adequacy of Prenatal Care Utilization Index [SAS computer program, version 3]. Chapel Hill, NC: Department of Maternal and Child Health, The University of North Carolina at Chapel Hill; 1994
    Search in Google Scholar
  • 15 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84: 1414-1420
    CrossrefPubMedSearch in Google Scholar
  • 16 Kramer MS, Platt RW, Wen SW , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108: E35
    CrossrefPubMedSearch in Google Scholar
  • 17 Kessner D, Singer J, Kalk CE, Schlesinger ER. Infant Death: An Analysis by Maternal Risk and Health Care. Contrasts in Health Status, Vol. 1. Washington DC: National Academy of Sciences; 1973
    Search in Google Scholar
  • 18 Delgado-Rodríguez M, Gómez-Olmedo M, Bueno-Cavanillas A, Gálvez-Vargas R. A comparison of two indices of adequacy of prenatal care utilization. Epidemiology 1996; 7: 648-650
    CrossrefPubMedSearch in Google Scholar
  • 19 VanderWeele TJ, Lantos JD, Siddique J, Lauderdale DS. A comparison of four prenatal care indices in birth outcome models: comparable results for predicting small-for-gestational-age outcome but different results for preterm birth or infant mortality. J Clin Epidemiol 2009; 62: 438-445
    CrossrefPubMedSearch in Google Scholar
  • 20 McGregor JA, French JI, Parker R , et al. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173: 157-167
    CrossrefPubMedSearch in Google Scholar
  • 21 Schulte J, Dominguez K, Sukalac T, Bohannon B, Fowler MG ; Pediatric Spectrum of HIV Disease Consortium. Declines in low birth weight and preterm birth among infants who were born to HIV-infected women during an era of increased use of maternal antiretroviral drugs: Pediatric Spectrum of HIV Disease, 1989–2004. Pediatrics 2007; 119: e900-e906
    CrossrefPubMedSearch in Google Scholar
  • 22 Su LL, Chong YS, Chan YH , et al. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial. BMJ 2007; 335: 596-599
    CrossrefPubMedSearch in Google Scholar
  • 23 Alexander GR, Kotelchuck M. Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research. Public Health Rep 2001; 116: 306-316
    PubMedSearch in Google Scholar
  • 24 Butz AM, Funkhouser A, Caleb L, Rosenstein BJ. Infant health care utilization predicted by pattern of prenatal care. Pediatrics 1993; 92: 50-54
    PubMedSearch in Google Scholar
  • 25 Liu Y, Liu J, Ye R, Li Z. Association of preconceptional health care utilization and early initiation of prenatal care. J Perinatol 2006; 26: 409-413
    CrossrefPubMedSearch in Google Scholar
  • 26 Kogan MD, Alexander GR, Jack BW, Allen MC. The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States. Pediatrics 1998; 102 (1 Pt 1) 25-30
    CrossrefPubMedSearch in Google Scholar
  • 27 Simpson SH, Eurich DT, Majumdar SR , et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 2006; 333: 15-18
    CrossrefPubMedSearch in Google Scholar
  • 28 Delgado-Rodríguez M, Gómez-Olmedo M, Bueno-Cavanillas A, Gálvez-Vargas R. Unplanned pregnancy as a major determinant in inadequate use of prenatal care. Prev Med 1997; 26: 834-838
    CrossrefPubMedSearch in Google Scholar
  • 29 McDonald TP, Coburn AF. Predictors of prenatal care utilization. Soc Sci Med 1988; 27: 167-172
    CrossrefPubMedSearch in Google Scholar
  • 30 Johnson AA, Hatcher BJ, El-Khorazaty MN , et al. Determinants of inadequate prenatal care utilization by African American women. J Health Care Poor Underserved 2007; 18: 620-636
    CrossrefPubMedSearch in Google Scholar
  • 31 Frisbie WP, Echevarria S, Hummer RA. Prenatal care utilization among non-Hispanic whites, African Americans, and Mexican Americans. Matern Child Health J 2001; 5: 21-33
    CrossrefPubMedSearch in Google Scholar
  • 32 Helfand M, Zimmer-Gembeck MJ. Practice variation and the risk of low birth weight in a public prenatal care program. Med Care 1997; 35: 16-31
    CrossrefPubMedSearch in Google Scholar
  • 33 Gould JB, Chavez G, Marks AR, Liu H. Incomplete birth certificates: a risk marker for infant mortality. Am J Public Health 2002; 92: 79-81
    CrossrefPubMedSearch in Google Scholar
  • 34 Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 1987; 65: 663-737
    PubMedSearch in Google Scholar
  • 35 Koroukian SM, Rimm AA. The “Adequacy of Prenatal Care Utilization” (APNCU) index to study low birth weight: is the index biased?. J Clin Epidemiol 2002; 55: 296-305
    CrossrefPubMedSearch in Google Scholar
  • 36 Murray JL, Bernfield M. The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan. N Engl J Med 1988; 319: 1385-1391
    CrossrefPubMedSearch in Google Scholar
  • 37 Dobie SA, Baldwin LM, Rosenblatt RA, Fordyce MA, Andrilla CH, Hart LG. How well do birth certificates describe the pregnancies they report? The Washington State experience with low-risk pregnancies. Matern Child Health J 1998; 2: 145-154
    CrossrefPubMedSearch in Google Scholar
  • 38 Roohan PJ, Josberger RE, Acar J, Dabir P, Feder HM, Gagliano PJ. Validation of birth certificate data in New York State. J Community Health 2003; 28: 335-346
    CrossrefPubMedSearch in Google Scholar