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Results for “PRENATAL CARE”

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PubMed1991

Combating infant mortality. A hospital collaborates with other groups to offer prenatal care in a rural area.

Prenatal care services are often lacking in poor rural areas. Consequently, rates of infant mortality and negative birth outcomes are relatively high. To address these problems, since 1987 St. Elizabeth Hospital Medical Center (SEHMC), Youngstown, OH, has successfully operated an innovative rural-based prenatal care clinic for indigent women. The Leetonia Clinic serves residents of Leetonia, OH, and about 20 surrounding communities. It offers on-site medical care using SEHMC obstetrics and gynecology residents and volunteer nurses. The local Catholic Charities organization funds a professional social worker. A prolife advocacy group and a women's self-help group offer volunteer counseling and referral services. They also manage paperwork at the clinic. The local Catholic church provides space in one of its school buildings to house the clinic. SEHMC also provides patient education and outreach. Over the past 4 years the clinic has served about 165 patients annually. About half are on welfare, and the rest are primarily self-paying. Studies are under way to assess the program's effect on infant mortality and morbidity.

Catholicism↗

PubMed2004

Reduced risk of inadequate prenatal care in the era after Medicaid expansions in California.

BACKGROUND: To improve perinatal outcomes in the United States, access to prenatal care was expanded through Medicaid and women were encouraged to enter prenatal care early. OBJECTIVE: The objective of this study was to determine if expanded eligibility for Medicaid increased use of prenatal care and reduced ethnic differences in use of prenatal care. RESEARCH DESIGN: We conducted secondary analysis of California birth certificate data for 1990, 1995, and 1998. SUBJECTS: We studied live-born singleton infants born to black, Asian, Latina, and white women (n = 1,483,951). MAIN OUTCOME MEASURES: Inadequate utilization of prenatal care. RESULTS: The proportion of live-born infants whose mothers had inadequate prenatal care decreased from 20% in 1990 to 14% in 1995 and 12% in 1998. In addition, the proportion of pregnant women with no insurance or who were self-paying fell from 13.1% in 1990 to 4.2% in 1995 and 3.6% in 1998 (P <0.001). Reductions in overall prevalence of inadequate use of prenatal care and ethnic disparities in use of prenatal care were not fully explained by increases in Medicaid coverage. CONCLUSIONS: Since California expanded access to Medicaid-funded prenatal care, there has been a substantial reduction in inadequate use of prenatal care and fewer women have no insurance or are self-paying. To further reduce ethnic disparities in use of health services, new policies must be developed to remove nonfinancial barriers to early and continuous use of prenatal care.

Adolescent↗

PubMed1996

Prenatal hospitalization and compliance with guidelines for prenatal care.

OBJECTIVES: This study examined the relationship between compliance with the US Public Health Service guidelines for prenatal care and the rate of prenatal hospitalization. METHODS: For all women admitted to a Boston referral center during January and February 1993 with a pregnancy of at least 18 weeks gestation (n = 1400), a proportional hazards model was used to examine factors associated with prenatal hospitalization. RESULTS: Prenatal hospitalization occurred during 248 (17.7%) pregnancies. The median length of stay for all prenatal admissions was 4 days; the medial total charge was $5667. Prior medical and obstetrical problems were strongly associated with prenatal hospitalization. After adjustment for age, race, and medical and obstetrical complications, women who received less than 70% of the prenatal care recommended were significantly more likely to be hospitalized (relative risk [RR] = 2.14, 95% confidence interval [CI] 1.50, 3.06). CONCLUSIONS: Prenatal hospitalization is a common, costly complication of pregnancy. Because of its association with compliance with the Public Health Service guidelines for the content of prenatal care, prenatal hospitalization may be a sentinel indicator of inadequate prenatal care amenable to intervention.

Adolescent↗

PubMedDate not supplied

Prenatal care and multiple pregnancy.

Prenatal care of multiple pregnancy presents a variety of nursing challenges. Specialized care, beginning in early pregnancy, can have a significant impact on the outcome for mothers and neonates. Dramatically increasing roles for advanced technology in the care of multifetal pregnancies must be balanced with families' needs for education and support.

Female↗

PubMed2002

Effective prenatal care for adolescent girls.

Provision of prenatal care for adolescents requires an understanding of routine prenatal care as well as developmental and psychosocial issues unique to this population. In this article, management of adolescent pregnancy, including the prenatal history, physical examination, diagnostic testing, and follow-up care are presented. Collaboration with other disciplines, which optimizes care, is also discussed.

Adolescent↗

PubMedDate not supplied

Prenatal care in developing counties: the World Health Organization technical working group on antenatal care.

As part of its work to help define and strengthen prenatal care, the World Health Organization convened a Working Group in November 1994 to formulate recommendations for prenatal care at the health center level. The Group agreed on the timing and content of a minimal number of visits for all women, as well as risk factors and medical conditions that should receive special care. In addition, several over-riding themes came out of the discussions. These included the need for prenatal care to be tailored to each woman's circumstances, the importance of developing a delivery plan appropriate to the woman's situation, the need to make prenatal care part of a functioning health care system in order for it to be effective, the appropriateness of the midwife as provider of prenatal care, and the need to educate and empower the entire community to address the causes of maternal morbidity and mortality. Operational research and evaluation of prenatal care practices are underway to identify the most effective and efficient ways to provide these services.

Developing Countries↗

PubMed1990

How postpartum women explain their lack of obtaining adequate prenatal care.

The quality of life for infants and children is often dependent on the adequacy of the prenatal care pregnant women receive. From July through to December 1985, 15% of pregnant women in one Midwestern county were identified as having inadequate prenatal care. The purposes of the study were to identify and analyse the reasons women in that county gave for not obtaining adequate prenatal care. In addition, chi-square was used to determine the relationship between the reasons given and the three variables, age, time between knowledge of pregnancy and making an appointment for care, and source of payment. A convenience sample (n = 44) was used in a study over a 5-month period at three locations. The Health Belief Model was the conceptual framework for this study. Insufficient money to pay for care was the primary reason given for not obtaining adequate prenatal care (81%). Other reasons included motivational issues (45%) and access or lack of transportation (19%). There was a significant relationship (P = 0.05) with four reasons to the variable of age and with three reasons to both the variables of time and source of payment. The following recommendations were identified as a result of this research: the need for subsidized prenatal care and the need for a community-wide education campaign regarding the need for adequate prenatal care and the consequences of inadequate care. Prenatal care is sometimes not available to all in the United States in spite of the relationship of infant mortality and the quality of life for infants and children to adequate prenatal care.

Attitude to Health↗

PubMed1997

First-time mothers' perceptions of prenatal care services.

This study sought to uncover information regarding prenatal care services as reported by primiparas. Inadequate prenatal care has been linked with the delivery of low birth weight (LBW) infants and infant mortality. This secondary analysis of a larger study (N = 426) examined the need for and availability, accessibility, and use of prenatal care services by primiparas (n = 141). Results indicated that primiparas delivering LBW infants reported less satisfaction with information on birth control and less information on infant feeding. In addition, mothers of LBW infants reported more often than mothers of normal birthweight infants that transportation and finances were barriers to prenatal care. Childbirth preparation class was the only predictor variable for birth weight in this study.

Adult↗

PubMed1991

Special issues in prenatal care outreach.

Approaches to prenatal care outreach taken by public providers vary widely. To date, few have evolved from systematic, data-based casefinding strategies. The following case study describes the findings of a research project concerned with both care seeking and care getting behaviors of low income women and the relationship between those behaviors and birthweight outcomes. Analysis of project data reveals that the greater the delay between seeking and getting care, the greater the likelihood of low birthweight. Application of this research data has yielded information useful to outreach planning, staff development and program evaluation procedures.

Community-Institutional Relations↗

PubMed1996

Prenatal care and prevention of preterm birth. A case-control study in southern Spain.

The value of prenatal care is controversial and difficult to establish. A national policy for improving perinatal outcomes was proposed and applied throughout Andalusia (Southern Spain) in 1984. Here we report the results of an evaluation of this health care program as regards the prevention of preterm delivery. Effectiveness of prenatal care was assessed on the basis of two case-control studies in a hospital setting: one performed before the program was implemented (1981-1982) and the second one six years after the program began (1990-1993). A total of 229 cases and 395 controls for the period 1981-1982, and 207 cases and 381 controls for 1990-1993 were selected. Prenatal care was assessed based on the number of prenatal care visits, the date of the first visit, and an American composite index adjusting for gestational age. Multiple-factor adjusted odds ratios and their 95% confidence intervals (CI) were estimated using unconditional logistic regression analysis. The use of prenatal care significantly improved across time: the proportion of women receiving no prenatal care decreased from over 30% to less than 5%, and the proportion of women starting prenatal care in the first trimester for 1990-1993 was three times greater than the figure for 1981-1982. In the 1981-1982 case-control study, the date of first visit and the composite index were shown to be unrelated to preterm birth risk; and the number of visits yielded a significant association, although no definite trend could be established. In the 1990-1993 case-control study, a clear and significant relationship was observed between the number of prenatal care visits, the trimester of the first visit, and the adequacy of care according to the composite index. This latter variable, reflecting a more stringent standard of prenatal care, was selected by a stepwise logistic regression analysis as the best predictor for preterm birth risk. The results suggest that the present Andalusian program helps prevent preterm delivery. Nonetheless, its minimum standards should be raised to further decrease preterm birth risk.

Adult↗

PubMedDate not supplied

Factors associated with adolescents' risk for late entry into prenatal care.

Risk factors for late entry into prenatal care were examined among 533 pregnant adolescents younger than 18. Forty-seven percent entered prenatal care after 12 weeks' gestation. Logistic regression analysis indicated that adolescents who no longer had contact with their baby's father were 4.2 times as likely as those who did to enter prenatal care after the first trimester. Adolescents with no history of abortion were 3.2 times as likely to enter care late as those who had had an abortion. Young women who had not used alcohol in the last 30 days and those with only one sex partner in the last 12 months were more likely than adolescents exhibiting riskier behavior to receive care late (odds ratios of 2.7 and 1.6, respectively). Odds of late entry into care were also elevated for those who were unemployed (1.9), black or white (1.9 and 1.7, respectively) and less educated (1.2).

Adolescent↗

PubMed1989

Prenatal care, infant birthweight and infant mortality in Puerto Rico.

This study purports to analyze selected demographic and socio-economic correlated of prenatal care in Puerto Rico. Also, the relationship between prenatal care and infant birthweight and mortality is examined. The data was obtained from the 1986 live birth and death certificates. Three indicators of adequacy of prenatal care were utilized in the analysis: number of prenatal care visits, trimester in which this care began and the "Kessner Index". The findings of the study revealed that prenatal care in Puerto Rico has improved both in terms of early care and in continuity, since 1980. Great geographical differences in adequacy of prenatal care were observed throughout the Island. Prenatal care varies considerably among different population subgroups. Inadequate prenatal care was more frequent among adolescent, unwed and high parity mothers as well as among those of the lowest socio-economic strata. Furthermore, these groups had the highest proportion of low birthweight babies and their offsprings, the highest mortality rates. The statistical evidence obtained from this study suggests that this is in part due to the inadequate prenatal care received by these mothers.

Adolescent↗

PubMed2000

Improved birth outcomes among HIV-infected women with enhanced Medicaid prenatal care.

OBJECTIVES: This study evaluated the impact of enhanced prenatal care on the birth outcomes of HIV-infected women. METHODS: Medicaid claims files linked to vital statistics were analyzed for 1723 HIV-infected women delivering a live-born singleton from January 1993 to October 1995. Prenatal care program visits were indicated by rate codes. Logistic models controlling for demographic, substance use, and health care variables were used to assess the program's effect on preterm birth (less than 37 weeks) and low birthweight (less than 2500 g). RESULTS: Of the women included in the study, 75.3% participated in the prenatal care program. Adjusted program care odds were 0.58 (95% confidence interval [CI] = 0.42, 0.81) for preterm birth and 0.37 (95% CI = 0.24, 0.58) for low-birthweight deliveries in women without a usual source of prenatal care. Women with a usual source had lower odds of low-birthweight deliveries if they had more than 9 program visits. The effect of program participation persisted in sensitivity analyses that adjusted for an unmeasured confounder. CONCLUSIONS: A statewide prenatal care Medicaid program demonstrates significant reductions in the risk of adverse birth outcomes for HIV-infected women.

Adult↗

PubMedDate not supplied

Reasons, health behaviors, and outcomes of no prenatal care: research that changed practice.

Changes in prenatal care practices resulted from a pilot study with 12 urban New Mexican women who received no prenatal care. The women were interviewed regarding their reasons for not receiving care during pregnancy, health behaviors, and perceived neonatal outcomes. Data on actual neonatal outcomes were taken from the medical record. Maternal reasons for no prenatal care were socio-demographic, system-related, attitudinal, and outside forces of job and childcare. To ensure a healthy baby, the women made changes in their nutrition, self-care activities, substance use, sleep, and exercise activities. All of the women perceived they had a healthy baby. Yet 61% of the neonates had complications and 45% were low birth weight. The research findings were used to develop a care management program that included case management and utilization management.

Adult↗

PubMed1996

Role of prenatal care in preterm birth and low birthweight in Portugal.

BACKGROUND: It remains unclear if benefits of prenatal care can be attributed to the amount and content of care or to uncontrolled risk factors that might also affect its use. This study was designed to evaluate the independent association between prenatal care adequacy and adverse pregnancy outcomes, measured either as the occurrence of preterm birth or low birthweight. METHOD: We studied 3734 single liveborn infants. Information on mothers' use of prenatal care, and demographic, anthropometric, behavioural, clinical and obstetric characteristics were obtained through questionnaire. Prenatal care was classified as inadequate, intermediate or adequate based on Kessner's Adequacy of Prenatal Care Index. To estimate the association of adequacy of prenatal care and the defined outcomes, both crude and adjusted odds ratios (OR) and 95 per cent confidence intervals (95 per cent CI) were calculated by means of unconditional logistic regression. RESULTS: Adequate and intermediate (compared with inadequate) prenatal care was significantly associated with a lower risk of preterm (OR = 0.20, 95 per cent CI 0.12-0.32, and OR = 0.35, 95 per cent CI 0.23-0.54, respectively) or low birthweight (OR = 0.23, 95 per cent CI 0.15-0.35, and OR = 0.31, 95 per cent CI 0.20-0.46, respectively). After adjusting for maternal age, social class, marital status, complications of pregnancy and type of hospital, the risk of preterm delivery remained significantly lower for women receiving adequate (OR = 0.18, 95 per cent CI 0.11-0.28) or intermediate care (OR = 0.35, 95 per cent CI 0.23-0.54). Adjusted for maternal body mass index, marital status, cigarette smoking, pregnancy weight gain and complications, type of hospital, newborn sex and gestational age, a significant decreased risk of low birthweight remained for infants of women with adequate (OR = 0.39, 95 per cent CI 0.23-0.65) or intermediate care (OR = 0.47, 95 per cent CI 0.29-0.76). CONCLUSIONS: Our findings show that in a population with free access to prenatal care, the quantitative adequacy of prenatal care has an independent effect on pregnancy outcome, whether assessed through the occurrence of preterm births or low birthweight infants.

Adult↗

PubMed1994

The risk of repeating low birth weight and the role of prenatal care.

OBJECTIVE: To estimate the influence of adequacy of prenatal care and other known risk factors on the risk of repeating low birth weight (LBW) (less than 2500 g). METHODS: This was a retrospective cohort study of women having two births in Washington state during 1984-1990, as recorded using linked birth certificate records. Logistic regression was used to control for maternal age, marital status, smoking, miscarriage, inter-pregnancy interval, and prenatal care. RESULTS: Compared to the reference group of women with normal-weight first births (at least 2500 g), women with LBW first births, either preterm or small for gestational age (SGA), were significantly more likely to have an LBW second birth. The estimated relative risk of repeating LBW in general was 7.0 (95% confidence interval 4.8-10.1). Smoking during the second pregnancy was a significant effect modifier. The risk estimates were not significantly affected by any of the other variables entered into the models, including adequate prenatal care. CONCLUSIONS: Prior delivery of a preterm or SGA LBW infant was the strongest predictor of LBW delivery in a subsequent pregnancy. Adequate prenatal care during the second pregnancy did not provide statistically significant protection against the risk of repeat LBW. The tendency for women to have repeat LBW deliveries despite adequate prenatal care indicates a need for a better understanding of the underlying pathophysiology of preterm and SGA delivery.

Adult↗

PubMed2004

Trends in prenatal care use and low birthweight in southeast Brazil.

OBJECTIVES: We investigated trends in prenatal care use and its association with low birthweight in a developing country. METHODS: We examined data from 2 southeast Brazilian cohort surveys, 1 conducted in 1978-1979 and the other in 1994. RESULTS: Socioeconomic inequalities in prenatal care use increased during the 15-year period of 1979-1994. Although prenatal care use increases paralleled increases in low birthweight rate during this period, having no prenatal care was associated with higher risk of low birthweight in both surveys. Inadequate prenatal care use was also associated with higher risk of low birthweight in 1978-1979 only. CONCLUSIONS: Increasing low birthweight rates among women who adequately used prenatal care may be causing a bias by reducing the estimates of the effect of inadequate prenatal care use on low birthweight rates.

Bias↗

PubMed1995

Alternative prenatal care. Impact of reduced visit frequency, focused visits and continuity of care.

OBJECTIVE: To investigate the impact of an alternative prenatal care program for low-risk patients. STUDY DESIGN: Five hundred forty-nine low-risk pregnant women were allocated to the study and control groups. The study group received, on average, eight visits, all of them with one of nine study providers. Each study visit had specific objectives and accompanying targeted patient education handouts. The control group received the usual prenatal care (on average, 13 visits) with different providers, according to the customary schedule. RESULTS: There were no significant pregnancy outcome differences between the groups. The study vs. control group differed significantly (P < .0001) in patient satisfaction regarding the number of prenatal visits. There was a higher level of satisfaction in the study group concerning continuity of care (P < .0001). The alternative prenatal care program reduced the number of prenatal visits by 27% and was not associated with any change in maternal or perinatal outcomes. Patient satisfaction parameters were either maintained or improved with alternative prenatal care. CONCLUSION: An alternative prenatal care program for low-risk patients reduced resource utilization without adversely affecting prenatal care process variables, pregnancy outcome or patient satisfaction.

Continuity of Patient Care↗