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Results for “PRENATAL CARE”

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PubMed2003

Maternal drug use and the timing of prenatal care.

This paper explores the role of maternal drug use and the timing of prenatal care. The study data were collected from women delivering live births at eight participating hospitals in the Washington, D.C., Metropolitan Area Drug Study. An estimated 16.9 percent of the women in this sample initiated prenatal care in their third trimester or received no prenatal care. After adjusting for age, race/ethnicity, education, parity, and attitude toward pregnancy, cocaine use was strongly associated with the timing of prenatal care. Using multivariable ordinal logistic regression, the data suggest significant barriers to prenatal care for substance abusers, especially cocaine users. Increasing access to prenatal care continues to be an important public health policy objective, particularly in urban areas where substance abuse is prevalent. Health services research must test strategies that address the timing of prenatal care among drug-dependent, urban women.

Adolescent↗

PubMed1996

Adequacy of prenatal-care utilization--California, 1989-1994.

A national health objective for the year 2000 is to increase to at least 90% of the proportion of pregnant women who receive prenatal care during the first trimester of pregnancy (objective 14.11). Adequate prenatal care is believed to result in better pregnancy outcomes, including reduced maternal and infant morbidity and mortality and reduced risk for preterm delivery and for low birthweight (<2500 g [<5 lb 8 oz]). However, measures of prenatal-care utilization based on first-trimester initiation of prenatal care address only the timing of prenatal-care initiation and do not include the frequency of visits thereafter, which can provide a more comprehensive measure of prenatal-care utilization. To calculate rates of prenatal-care utilization for California during 1989-1994, the California Department of health Services (CDHS) analyzed data from birth certificates using a more comprehensive measure of prenatal-care utilization. This report presents annual rates of adequate prenatal-care utilization (APNCU) for California during 1989-1994 (the most recent year for which complete data were available), compares these data with the year 2000 objective for prenatal-care utilization, and examines rates of APNCU in California by payment source (for prenatal care) for 1989, 1992, and 1994.

California↗

PubMed2006

At the back stage of prenatal care: Japanese Ob-Gyns negotiating prenatal diagnosis.

In this article, I explore the reluctance of Japanese ob-gyns to discuss prenatal diagnosis (PND) tests with pregnant women. The analysis focuses on the culturally specific ways in which ob-gyns formulate their cautiousness and criticism toward PND while invoking a local moral economy. Analyzing ob-gyns' accounts, I show how the ambiguities of PND are constituted in a specific moment in Japanese culture, history, disability politics, and national reproductive policies and are formulated through local paradigms of thinking about pregnant women, their fetuses, and the process of becoming a person in Japanese society. Finally, I show how PND in Japan is pushed to a "back-stage" realm in which the diagnosis for fetal anomalies is practiced in secrecy.

Amniocentesis↗

PubMed2005

Timing of enhanced prenatal care and birth outcomes in New Jersey's HealthStart program.

OBJECTIVE: This study examined the effects of prenatal care and the timing of its initiation on birth weight and gestational age outcomes among women in a state-wide Medicaid enhanced prenatal care program. METHODS: Ordinary Least Squares and logistic regression analyses were performed using data on 88,196 births in New Jersey between 1988 and 1996. A large number of potentially confounding factors were included. RESULTS: Initiating prenatal care in the first trimester was associated with a 56 g advantage in birth weight (p = .01) compared to no care. Initiating prenatal care in the first or second trimester was associated with a 1 day advantage in gestational age (p = .05). There were no significant effects of prenatal care, initiated in any trimester, on low-birth weight. Initiating care in the first versus the second trimester had no effect on the probability of delivering preterm. The findings did not vary by sociodemographic subgroup. CONCLUSION: This study provides support for claims that there is little that prenatal care can do to improve aggregate birth outcomes because most pregnancy complications are the result of behaviors and life circumstances that precede the pregnancy and are very difficult to reverse. Prenatal care, even with enhanced services, appears to offer too little, too late.

Adolescent↗

PubMed1998

Improving prenatal care services for low-income African American women and infants.

Increasing the level of prenatal care among African American women may be one method of improving the health and well-being of African American women and children. This article identifies factors influencing access to and use of prenatal care and strategies for increasing the use of prenatal care among low-income African American women. Barriers to prenatal care, the strengths and limitations of prenatal care in reducing infant mortality and improving infant outcomes, and the importance of providing more comprehensive prenatal care that addresses both the medical and psychosocial needs of the low-income African American mother and her infant are discussed. Changes in prenatal care services that include the medical and lay communities, public health organizations, public policy organizations, and medical financing institutions are identified.

Adult↗

PubMed1999

Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995.

OBJECTIVE: Although poor prenatal care is detrimental to maternal and infant health, few studies have assessed the adequacy of prenatal care among women with psychiatric diagnoses. This investigation examined the association between chart-recorded psychiatric and substance use diagnoses at the time of delivery and adequacy of prenatal care among all women delivering babies in California hospitals during 1994 and 1995. METHODS: The authors undertook an archival analysis of data from the California Health Information for Policy Project (CHIPP), which consists of linked hospital discharge and birth certificate data for 1,094,178 deliveries in 1994 and 1995. The associations between International Classification of Diseases, 9th Revision, Clinical Modification psychiatric and substance abuse diagnoses and level of prenatal care were examined. Logistic regression analyses were conducted to assess the association between maternal diagnostic category and inadequate prenatal care while controlling for payment source, age, education, race, marital status, and parity (previous births). RESULTS: Women who received psychiatric and substance use diagnoses demonstrated significantly increased risk of inadequate prenatal care compared with women without those diagnoses. CONCLUSIONS: Psychiatric diagnoses were associated with an increased risk of inadequate prenatal care; the association between psychiatric and substance use diagnoses and poor prenatal care persisted even after the analysis controlled for known risk factors. Future investigations will need to elucidate the processes of prenatal care for women with psychiatric disorders so that preventive interventions can be developed.

Adult↗

PubMed2000

Increasing access to prenatal care: an evaluation of minority health coalitions' early pregnancy project.

Early prenatal care utilization is a problem for racial and ethnic minority women in Indiana. Minority health coalitions in Indiana developed early pregnancy care coordination projects to address this need. To evaluate project outcomes, birth certificates of infants born to project mothers were matched with birth certificates of infants whose mothers did not receive care coordination. Results showed that project mothers were significantly more likely to start prenatal care earlier, had better prenatal care utilization as measured by the Kessner Index (Kessner, Singer, Kalk, & Schlesinger, 1973), and had better adequacy of care as measured by the APNCU Index (Kotelchuck, 1994) than the noncare-coordinated mothers. Although the project was successful in meeting its primary objective, specific recommendations are made for community health nurses to partner with the coalitions in improving the content of prenatal care, decreasing sociocultural barriers to care, and assisting in the evaluation of outcomes of future projects.

Adolescent↗

PubMedDate not supplied

Area-level predictors of use of prenatal care in diverse populations.

Patterns and predictors of the use of prenatal care in Hawaii were examined by census tract, taking into account summary measures of socioeconomic status, environmental conditions, and aggregated indicators of pregnancy-related risk characteristics of mothers. The objectives of the study were to identify those census tracts with high levels of inadequate use of prenatal care services; to develop a model, based on census tract characteristics, to explain observed geographic variations in the use of prenatal care services; and to identify for further investigation specific localities with unanticipated patterns of use. Data were drawn from 1980 census reports and vital statistics live birth files for the period 1979-87. Regression analysis was used to develop a model that was able to predict 61 percent of the census tract variation in the percentages of inadequate use of prenatal care services. Increased proportions of mothers of Japanese and other Asian-descent and of adults with more than high school education were associated with low levels of inadequate use of prenatal care services. Increased proportions of high parity-for-age risk and Samoan mothers were associated with higher levels of inadequate use. Census tract maps of actual and predicted percentages and studentized residual values were used to identify areas with high and low rates of inadequate use of prenatal care services. The area-level methods used are believed applicable to health care planning in other areas with ethnically or socioculturally diverse populations.

Demography↗

PubMed1980

Prenatal care and pregnancy outcome.

The relationship of prenatal care to perinatal outcome was studied in a racially and socioeconomically homogeneous population. All patients who were delivered at the E. H. Crump Women's Hospital and Perinatal Center from July 1 to December 31, 1979, were divided into two groups, based on the amount of prenatal care received. One group of 1,102 patients had 0 to 3 prenatal visits (average 1.43); the second group, consisting of 2,027 patients, had four or more visits (average 12.78). Both groups were similar with respect to age, marital status, previous obstetric history, and initial risk assessment. However, the group with inadequate prenatal care had significantly higher fetal, neonatal, and perinatal mortality rates.

Female↗

PubMed2005

Is prenatal care really ineffective? Or, is the 'devil' in the distribution?

Prenatal care should improve infant health, yet research frequently finds only weak effects. If there are two kinds of pregnancies, 'complicated' and 'normal' ones, then combining these pregnancies may lead prenatal care to appear ineffective. Data from the National Maternal and Infant Health Survey (NMIHS) offers compelling evidence. The standard 2SLS approach yields obviously bimodal residuals and frequently insignificant prenatal care coefficients. In contrast, estimating birth weights with a finite mixture model yields estimates revealing that prenatal care has a substantial effect on 'normal' pregnancies. Our Monte Carlo experiment confirms that ignoring even a small proportion of 'complicated' pregnancies can lead prenatal care to appear unimportant.

Female↗

PubMed1998

Personal costs associated with high-risk prenatal care attendance.

Personal costs associated with attending prenatal care may influence women's care-seeking behavior, particularly poor, pregnant women and those with complicated pregnancies who receive more visits. This study described personal costs incurred by poor, high-risk pregnant women while attending care. Personal costs included direct out-of-pocket and time costs. Also, the relationship between personal costs and attendance was examined. Mean direct costs throughout pregnancy were $101.96 per patient. Women waited a mean of 3.22 hours per visit for care and received direct physician care for a mean of 5 minutes. As child care costs increased, attendance decreased significantly (r = 0.60, p < or = 0.05). As transportation costs, meal costs, wages lost, and time spent awaiting care increased, attendance decreased. Prenatal care has associated dollar and time costs for patients. Problem solving these issues with patients is critical. System changes to decrease waiting times and to address child care issues are needed.

Adult↗

PubMedDate not supplied

Quantifying the adequacy of prenatal care: a comparison of indices.

OBJECTIVES: In spite of the widespread use of prenatal care utilization indices in the scientific literature, little attention has been given to the extent to which these indices are comparable. This investigation contrasts the way five indices classified cases into categories of prenatal care use. METHODS: From the 1989-1991 South Carolina Public Use data files, single live births to resident mothers were selected for analysis (N = 169,082). Five prenatal care indices were compared: (a) the modified Institute of Medicine (Kessner) index, (b) a variation of the IOM index using the full American College of Obstetrics and Gynecology visit recommendation, (c) an index derived from the recommendations of the U.S. Public Health Service Expert Panel on Prenatal Care, (d) the GINDEX, and (e) the APNCU index. RESULTS: The proportion of cases assigned to prenatal care utilization categories by each index varied markedly, ranging from 33.6% to 58.1% for adequate care, 9.2% to 20.3% for inadequate care, and 7.4% to 22.6% for intensive utilization. CONCLUSIONS: The selection of a prenatal care utilization index for research and policy development purposes requires a careful consideration of the intent, criteria for defining adequacy, and coding assumptions of each index. As these indices are conceptually distinct in their measurement approach, they are likely to yield different patterns of prenatal care use in a population and cannot be used interchangeably. Recommendations for their use are provided.

Algorithms↗

PubMed1992

Medicaid costs and birth outcomes: the effects of prenatal WIC participation and the use of prenatal care.

This study examines the effects of prenatal WIC participation and the use of prenatal care on Medicaid costs and birth outcomes in five states--Florida, Minnesota, North Carolina, South Carolina, and Texas. The study period is 1987 for Florida, Minnesota, North Carolina, and South Carolina and January-June 1988 for Texas. Prenatal WIC participation was associated with substantial savings in Medicaid costs during the first 60 days after birth, with estimates ranging from $277 in Minnesota to $598 in North Carolina. For every dollar spent on the prenatal WIC program, the associated savings in Medicaid costs during the first 60 days ranged from $1.77 to $3.13 across the five states. Receiving inadequate levels of prenatal care was associated with increases in Medicaid costs ranging from $210 in Florida to $1,184 in Minnesota. Prenatal WIC participation was associated with higher newborn birthweight, while receiving inadequate prenatal care was associated with lower birthweight.

Data Collection↗

PubMedDate not supplied

Perceived barriers to prenatal care services.

PURPOSE: The purpose of this study was to determine barriers to prenatal care services and to determine if barriers differed by demographic characteristics in a low-income population. DESIGN: Descriptive correlational study with 110 women who sought prenatal care after the 20th week of gestation. RESULTS: Two items were major barriers to seeking prenatal care: long waiting times at the time of appointments and the cost of getting care. Significant relationships were found based on the age and race of the women. CLINICAL IMPLICATIONS: Some identifiable variables prevented these women from seeking early prenatal care; however, the barriers identified are amenable to change. Strategies to reduce barriers could include providing more culturally competent care, more timely appointments, better use of the woman's time when appointments are kept, educating women in the community about the availability of low-cost care, and assistance at prenatal care sites for facilitating completion of insurance and financial applications. Barriers to prenatal care varied by demographic group; therefore, identifying the characteristics of the group being served seems important in efforts to decrease barriers to care.

Adolescent↗

PubMed2004

Prenatal care utilization and the implementation of prophylaxis to prevent perinatal HIV-1 transmission.

OBJECTIVES: To describe prenatal care utilization among women with HIV-1 in 4 US states, and to determine whether the adequacy of prenatal care utilization is associated with the implementation of prenatal, intrapartum, and postnatal HIV antiretroviral therapy (ARV). METHODS: Three-hundred three women completed a prenatal interview. Prenatal, labor and delivery, and infant medical records were reviewed. RESULTS: Thirty-nine percent of women did not receive adequate prenatal care; nearly one quarter of women did not begin care within the recommended timeframe, and approximately one-fifth of women received fewer than the recommended number of prenatal care visits from the time of entry into care until delivery. Those classified as less than adequate in terms of receipt of recommended visits were at increased risk for not receiving ARV during the prenatal care period and during labor and delivery, and were more likely to have had an infant subsequently diagnosed with HIV infection. CONCLUSION: Although women with HIV require adequate prenatal care for their own health as well as to improve perinatal outcomes, many are at risk for not receiving this care. Lower adherence to prenatal care appointments is an important risk factor for not receiving full HIV prophylactic regimens.

Adult↗

PubMedDate not supplied

The content of prenatal care. Update 2005.

INTRODUCTION: The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time. METHODS: The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed. RESULTS: The USPHS recommendation of a reduced prenatal visit schedule has support, and new content for the preconception visit has been identified, although this preconception visit has not been validated or widely implemented. CONCLUSIONS: We identified new opportunities and initiatives for the content of prenatal care, particularly improvement in the electronic medical record, attention to multidisciplinary approaches to patient education and improved patient literacy, and an extended maternal life span approach, including postgestation visits.

Benchmarking↗

PubMedDate not supplied

Prenatal care needs assessment comparing service use and outcomes in Fresno, CA.

The authors performed a prenatal care needs assessment for Fresno County, CA, using data from a sample of 11,878 birth certificates for the county for 1989. Birth records, patterns of prenatal care utilization, and low birth weight outcomes in the county were compared with those in a random sample of 11,826 certificates derived from births in the remainder of the State. Bivariate techniques were used in calculating care utilization rates. Multivariate logistic regression analysis was used in associating rates of prenatal care visits and gestational month of initiation of prenatal care with low weight birth outcomes. County women entered prenatal care as early as women in the remainder of the State, but did not return as often for prenatal care visits. Their rate of return for followup visits was 29.9 percent, compared with 24.8 percent for women in all other counties (P < 0.001). County women with the lowest rates of visits had 1.4 to 1.9 times the risk of having a low weight birth than other county women with higher rates of visits, and a significantly higher risk than for women of all other counties. An intensive visit schedule for high-risk care was provided 28.9 percent of county women, compared with 33.0 percent of women in all other counties (P < 0.001). County women who received a high-risk intensive visit schedule were 2.5 times more likely to have a low weight birth than county women who did not receive the schedule. For all other women in the State, the comparable risk was 2.1 times. Improvements in the number and content of prenatal care visits were shown to have a high likelihood of substantially improving birth weight outcomes for pregnancies among Fresno County women.

Adolescent↗

PubMed2000

Prenatal care utilization among low-income African American women.

The purpose of this study was to assess prenatal care utilization among low-income African American women, examine the relations of demographic and other selected variables to the adequacy of prenatal care utilization, and to describe the women's positive and negative experiences with prenatal care. The sample consisted of 126 African American women who had a child 1 year old or younger. A structured interview developed by the investigator was used. Adequacy of prenatal care utilization (APNCU) was calculated using Kotelchuck's index (Kotelchuck, 1994b). The findings indicated that 13% of the women did not receive any prenatal care and that only 50.8% of the women had adequate utilization of prenatal care. Women who perceived prenatal care as important utilized the services significantly more than other women, chi 2(1, N = 126) = 8.04, p = .01. Demographic variables, presence of health problems during pregnancy, and whether or not pregnancy was planned were not significantly related to APNCU. Several positive aspects of prenatal care were expressed by the women, and 24% of those who obtained care stated that there was nothing negative about it. The negative experiences mentioned by some women were clinic waiting time, waking up in the morning, transportation difficulties, having morning sickness, and disliking seeing a doctor.

Adolescent↗