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PubMed2000

Measurement error in prenatal care utilization: evidence of attenuation bias in the estimation of impact on birth weight.

OBJECTIVE: Errors in the measurement of the timing and number of prenatal care visits may produce downward bias in estimates of the impact of prenatal care use on birth outcomes. This paper examines the extent of attenuation bias from measurement error in the estimation of the effect of prenatal care use on birth weight. METHODS: Data were analyzed from the 1980 National Natality Survey, a nationally representative sample of live births with information on prenatal care utilization from three sources: birth certificates, medical provider surveys, and maternal surveys. The extent of attenuation bias in estimates of the impact of different measures of prenatal care use on birth weight was examined by comparing estimates robust to measurement error (including instrumental variables) with ordinary least squares results. RESULTS: There is considerable disagreement in measures of prenatal care across the three data sources, with correlations in the utilization measures computed from different sources around 0.5. The results also show evidence of attenuation bias from measurement error in estimates of the impact of prenatal care on birth weight for both White and Black mothers. Attenuation bias was least severe for information from the birth certificate report of prenatal care. CONCLUSIONS: Because of measurement error, previous studies may have underestimated the effect of prenatal care utilization on birth weight. Corrected estimates, however, do not suggest that prenatal care is a major predictor of birth weight. In addition, part of what previous analyses have interpreted as adverse selection bias may in fact be attenuation bias due to measurement error.

Birth Weight↗
PubMed1998

Measuring satisfaction among low-income women: a prenatal care questionnaire.

OBJECTIVE: To evaluate the reliability and construct validity of a prenatal care satisfaction scale. METHOD: A prenatal care satisfaction scale that included six dimensions of care based on the literature was tested during a telephone interview with 101 first-time African-American and Mexican-American mothers 18 and over who receive Medicaid. RESULTS: The scale exhibited high reliability (Cronbach's alpha = 0.95), as well as good construct validity. The correlation between the scale and rating of the quality of care overall was 0.74 (p < 0.001); the correlation between the scale and whether the women would recommend this provider to a friend was 0.67 (p < 0.001). Results from correlation and factor analysis suggested a different set of dimensions than those described in the literature. CONCLUSION: The 22-question satisfaction with prenatal care scale has excellent reliability and construct validity and taps six established dimensions of satisfaction, including the art of care, technical quality, access, physical environment, availability, and efficacy. The multidimensional scale allows for alternative groupings of the domains of satisfaction as our understanding of prenatal care satisfaction increases.

Adolescent↗
PubMed1991

An outcome evaluation of the content and quality of prenatal care.

Linkage of measures of the adequacy, content, and quality of prenatal care with pregnancy outcome is a long-standing research challenge. We attempted to improve on prior studies by developing a measure of prenatal care that encompasses the specific items thought to mediate its relationship with birthweight and by then examining the association of this measure with birthweight. An eight-item index of prenatal care was used to abstract information from the medical records of 63 white and 56 black women who gave birth to low-birthweight (less than 2500 g) infants and 61 white and 101 black women who gave birth to normal-weight (3000 + g) infants in 1987 at two Kaiser Permanente facilities. In univariate analyses the mean values for the index were higher in controls than in cases for both black and white women, but the difference was statistically significant only for blacks. In multivariate analysis the index was not significantly associated with the risk of low birthweight for whites or blacks. Prenatal care was extremely homogeneous in this population, which compromised the evaluation of the index as a correlate of low birthweight. We believe that this is a promising method for assessing the content of prenatal care and studying the association between content and outcome of care.

Black or African American↗
PubMed1995

Search behavior and choice of physician in the market for prenatal care.

The authors examine how 963 expectant mothers in Florida searched for and selected a prenatal care provider. Overall, the results suggest that women search for prenatal care in much the same way as search theory predicts. Nevertheless, the amount of search reported is surprisingly small. Less than a quarter of the women in the survey seriously considered more than one physician, and even among this group, less than 60% actually spoke to or visited a second physician. Because of the timing, importance, and relative frequency of pregnancy, it is probably easier to search for a prenatal care provider than it is to search for most other medical services. Consequently, if search is this uncommon for prenatal care providers, it is probably even less common for other procedures. As they search for and choose a prenatal care provider, pregnant women rely most heavily on information from friends and acquaintances. Women facing high coinsurance rates or whose choices are constrained by HMO or Medicaid coverage rely less on recommendations from friends and acquaintances. These women also appear less satisfied with their choice of prenatal care provider.

Adult↗
PubMed1994

[Determinants of prenatal care utilization among low income families in Paraíba State, Brazil].

The determinants of prenatal care in the state of Paraíba, Brazil, are examined. A population of 769 rural and urban women resident in the municipality of Caaporã and who had had a child within the five years immediately preceding the survey were interviewed. It was found that there are deficiencies in the provision of health services, especially in the rural area. While 80 percent of the women resident in the urban area had some prenatal care, more than 40 percent of women in the rural area had received no prenatal care at all. Through cross tabulations and multivariate analysis, the study assesses the differentials in the utilization or services and the net effect of sociodemographic variables on the use of prenatal care. It was found that there is a positive association between education and pregnancy of use of prenatal care and a negative association between rural residence and the use of prenatal care.

Adolescent↗
PubMed1994

The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight.

The proposed Adequacy of Prenatal Care Utilization Index is applied to data from the 1980 National Natality Survey to assess the adequacy of prenatal care utilization and its association with low birthweight in the United States. The index suggests that only 61.1% of women received adequate prenatal care, including 17.7% with more intensive care; 16.7% received inadequate care. More White women (63.4%) than Black women (51.9%) received adequate prenatal care. Low-birthweight rates were elevated among women with inadequate prenatal care and among those who received more intensive prenatal care.

Black or African American↗
PubMed2002

Prenatal care and black-white fetal death disparity in the United States: heterogeneity by high-risk conditions.

OBJECTIVE: To determine the impact of prenatal care in the United States on the fetal death rate in the presence and absence of obstetric and medical high-risk conditions, and to explore the role of these high risk conditions in contributing to the black-white disparity. METHODS: This is a population-based, retrospective cohort study using the national perinatal mortality data for 1995-1997 assembled by the National Center for Health Statistics. Fetal death rate (per 1000 births) and adjusted relative risks were derived from multivariable logistic regression models. RESULTS: Of 10,560,077 singleton births, 29,469 (2.8 per 1000) resulted in fetal death. Fetal death rates were higher for blacks than whites in the presence (4.2 versus 2.4 per 1000) and absence (17.2 versus 2.5 per 1000) of prenatal care. Lack of prenatal care increased the (adjusted) relative risk for fetal death 2.9-fold in blacks and 3.4-fold in whites. Blacks were 3.3 times more likely to have no prenatal care compared with whites. Over 20% of all fetal deaths were associated with growth restriction and placental abruption, both in the presence and absence of prenatal care. Lack of prenatal care was associated with increased fetal death rates for both blacks and whites in the presence and absence of high-risk conditions. CONCLUSION: In the Unites States, strategies to increase prenatal care participation, especially among blacks, are expected to decrease fetal death rates.

Black or African American↗
PubMed1997

Racial differences in perceived barriers to prenatal care.

OBJECTIVES: It is well known that black women are less likely to receive adequate prenatal care than white women. This study examines whether there are differences in barriers to prenatal care reported by black and white mothers. METHOD: Data from the 1988 National Maternal and Infant Health Survey were used to measure relationship between race and reported financial, service, and personal barriers to prenatal care use, adjusting for maternal age, parity, education, poverty level, and insurance coverage during pregnancy. All analyses were stratified by marital status because of substantial effect modification. RESULTS: Among married women, 12.1% of black women reported at least one barrier to prenatal care compared to 9.8% of white women. However, after adjustment for demographic and socioeconomic factors, black women were less likely to report a barrier odds ratio [OR] of 0.8; 0.6-1.0). Unmarried black women were less likely to report any barriers to care than white unmarried women (17.9% vs. 25.6%). After adjustment, the OR was 0.4 (0.3-0.5). CONCLUSIONS: This study suggests that though black women are less likely to receive prenatal care than white women, they are less likely to report barriers to such care. This may be due to differing expectations from the health system. The investigation of perceived barriers to care is important to the consequent understanding of what steps must be taken to assure that pregnant women do not experience obstacles to the receipt of prenatal care.

Adolescent↗
PubMed1991

Process, costs, and outcomes of community-based prenatal care for adolescents.

An evaluation of a community-based prenatal care program for teens compared 180 adolescent clients with a sample of adolescents matched on age and year of delivery who received care through a traditional prenatal care program at a university medical center. Evaluation criteria describing the process of receiving care were the mean number of prenatal visits, nonscheduled outpatient visits, nonstress tests, ultrasounds, and inpatient days during pregnancy. The two programs were significantly different as measured by these criteria. Outcome criteria included gestational age, birthweight, the percentage of infants requiring neonatal intensive care, and the percentage of clients with maternal complications. A multivariate analysis showed no statistically significant differences in these outcomes. The average cost of resources consumed during prenatal care for the study group was 41% that of controls.

Adolescent↗
PubMed2001

Variables that explain variation in prenatal care in Turkey; social class, education and ethnicity re-visited.

The extent and quality of prenatal care are important for the health of women and their babies. Recent studies suggest that women lack adequate prenatal care in contemporary Turkey. This paper uses regression models to examine the major factors impacting on the access of women to prenatal care through the 1993 Turkish Demographic and Health Survey. The findings suggest that after controlling for class, ethnicity does not explain the likelihood of a woman's access to prenatal care, partly because the predominant patriarchal ideology in Turkey determines women's access to education, which in turn determines their access to prenatal care. It can be argued that unless women's socioeconomic status in the family improves, their access to health care in general and prenatal care in particular will not increase significantly.

Educational Status↗
PubMedDate not supplied

Psychosocial factors and the timing of prenatal care among women in New Jersey's HealthStart program.

CONTEXT: Helping high-risk pregnant women obtain prenatal care early is the main policy goal of most U.S. publicly funded programs aimed at reducing the incidence of low birth weight and infant mortality It is therefore crucial to understand the factors that influence when women initiate prenatal care. METHODS: The effects of psychosocial and demographic risk factors on the timing of entry into prenatal care were estimated using data on roughly 90,000 Medicaid recipients who participated in New Jersey's HealthStart prenatal care program. RESULTS: Overall, 37% of women began prenatal care in the first trimester. Multivariate logistic regression indicated that women who lived in poor housing conditions and those who smoked, drank or used hard drugs had a reduced likelihood of entering care early (odds ratios, 0.8-0.9), while those who had clinical depression or who experienced domestic violence or abuse had elevated odds of early entry (1.1-1.2). The risk factor with the greatest impact on the timing of prenatal care was the wantedness of the pregnancy; women whose pregnancy was unwanted had dramatically reduced odds of entering care early (0.4). Separate analyses of women of varying racial and ethnic backgrounds demonstrated the differential effects of risk factors, the importance of including ethnicity with race and the universal impact of wantedness across racial and ethnic groups. CONCLUSIONS: Entry into prenatal care for at-risk women is affected by factors from multiple domains. It is important for prenatal programs to recognize the complexity of the issue as well as the barriers that different subgroups of women face.

Adolescent↗
PubMed1982

Prenatal care and child health.

Child health begins long before the birth of the baby. At they very least, child health care begins with prenatal care, but preferably begins with the mother's prior health as a child and adolescent herself. The longitudinal intergenerational viewpoint is necessary in order to improve the health status of infants and children. Many societal and demographic factors influence child health and child health care. The education, socioeconomic, and employment status of the parents are important, as well as their age, marital status, and family health history. Their geographic residence (urban, rural), health knowledge, and the degree of development of medical and health care resources play an important role in the availability and utilization of health care, both for themselves and their children.

Attitude to Health↗
PubMed1994

The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada.

OBJECTIVES: Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. METHODS: Measures of prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12,646 pregnant women. Maternal socioeconomic status was derived from small-area census data. RESULTS: Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The difference in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was no greater among women with pregnancy complications. CONCLUSIONS: The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care.

Adolescent↗
PubMed1998

[Kessner index as an exponent of prenatal care].

The aim of the study was evaluation of quality of prenatal care by Kessner Index, assessment of the effect intensity of prenatal care on the course of pregnancy and labour, as well as the ultimate delivery effect. The study covered females who gave birth at the Regional Hospital in Bychawa. Data concerning 319 women were analysed. The material obtained was subject to statistical analyses with the use of computer statistical package SPSS/PC 5.01. Prenatal care evaluated by Kessner Index was on the medium level, with the greatest number of pregnant females covered by intermediate care -55.8%. This care was significantly worse among rural females. No significant effect of adequate prenatal care on the ultimate delivery effect was noted, with the best results obtained among females covered with intermediate care.

Adult↗
PubMedDate not supplied

Piecing together the crazy quilt of prenatal care.

The failure to provide adequate prenatal care for low-income pregnant women in the United States and the effects of this failure on infant mortality are well known. Many studies have identified institutional barriers against access to care as a major cause. To overcome these barriers, Public Health District V, South Central Idaho, has created a comprehensive prenatal health care model that has almost tripled participation in its program during the first year of implementation and increased it again significantly during the second year. This decentralized pregnancy program has succeeded in getting all of the physicians offering obstetrical care in the district to serve low-income pregnant clients on a rotating basis. The new program provides pregnancy testing as well as financial screening services. Also, it has combined support services into one-stop-shopping clinics that include an innovative expansion of the Women, Infants and Children (WIC) Program of the U. S. Department of Agriculture. WIC food vouchers help attract clients into the prenatal care system and keep them coming. Enrichment of the duties of the public health nurse provides case coordination that pulls together the patchwork of medical and support services for the pregnant client.

Continuity of Patient Care↗
PubMed2004

A new method for classifying patterns of prenatal care utilization using cluster analysis.

OBJECTIVES: The objectives of this study were: to 1) define patterns of prenatal care utilization using cluster analysis, 2) describe two alternative cluster solutions and compare these groupings to the Adequacy of Prenatal Care Utilization Index (APNCU), 3) compare the cluster solutions and the APNCU with respect to maternal age and prematurity, and 4) discuss advantages and disadvantages of using cluster analysis to study prenatal care. METHODS: The study sample included 3544 women in the 1988 National Maternal and Infant Health Survey for whom complete prenatal care visit data were available. Clustering was carried out in two stages, first employing nearest centroid sorting (the k means method), a nonhierarchical approach, and then using Ward's Minimum Variance Method, a hierarchical clustering technique. RESULTS: Patterns of prenatal care defined by cluster analysis varied by timing of the first visit, total number of visits, and the rate of accumulation of visits, but this variation was different compared to that seen for the APNCU. While the cluster solutions and the APNCU identified a similar normative pattern of care, other patterns identified were quite different. In particular, the six-cluster solution differentiated among women who entered care at similar times, but accumulated visits at differing rates and experienced differing rates of preterm delivery. CONCLUSION: Cluster analysis is a new tool for studying prenatal care. Further studies are needed to refine the method and test whether the alternative perspective it provides will lead to new findings concerning the relationship of prenatal care and birth outcomes.

Birth Certificates↗
PubMed1997

Patterns of prenatal care initiation in Georgia, 1980-1992.

OBJECTIVE: To determine whether characteristics in a woman's first pregnancy were associated with the trimester in which she initiated prenatal care in her second pregnancy. METHODS: Data for white and black women whose first and second pregnancies resulted in singleton live births between 1980 and 1992 were obtained from Georgia birth certificates (n = 177,041). Adjusted relative risks (RRs) for early prenatal care in the second pregnancy were computed by logistic regression models that included trimester of prenatal care initiation, infant outcomes, or maternal conditions in the woman's first pregnancy as the exposure and controlled for maternal age, education, child's year of birth, interval between first and second pregnancy, presence of father's name on the birth certificate, and the interaction between prenatal care and education. Models were stratified by race. RESULTS: Women of both races who initiated prenatal care in the first trimester of their first pregnancies were more likely than those with delayed care to initiate prenatal care in the first trimester of their second pregnancies (RR = 1.25 and 1.63 for white and black women educated beyond high school, respectively). Both white and black women who delivered a baby with very low birth weight (RR = 1.06 and 1.15, respectively) or who suffered an infant death (RR = 1.09 and 1.31, respectively) in their first pregnancies were more likely than those who did not experience these events to begin prenatal care in the first trimester of their second pregnancies. CONCLUSION: Women with some potentially preventable adverse infant outcomes tend to obtain earlier care in their next pregnancy. Unfortunately, women who delayed prenatal care in their first pregnancy frequently delay prenatal care in their next.

Female↗