SEARCH · PubMed Health

Results for “PRENATAL CARE”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMed1992

The effects of variations in AFDC and Medicaid eligibility on prenatal care use.

Despite substantial evidence linking improved pregnancy outcomes with receipt of prenatal care and recent improvements in prenatal care utilization, specific subpopulations continue to receive less than adequate care. The study reported here examined the effects on prenatal care utilization of differences among states in AFDC and Medicaid eligibility policies. The study was based on information obtained from birth certificates and a mailed questionnaire to stratified random samples of all women experiencing live births during specified periods in four states. States were selected to provide comparisons between two states with liberal AFDC and Medicaid eligibility standards--Wisconsin and Colorado--and two states--Maine and Texas--which had more restrictive standards at the time data were collected. Study findings generally indicate that more liberal AFDC/Medicaid eligibility standards improve the adequacy of prenatal care among low income women. They also suggest, however, that the often lengthy eligibility process may actually pose barriers to care.

Aid to Families with Dependent Children↗

PubMed2003

Selection bias in prenatal care use by Medicaid recipients.

OBJECTIVE: This study examines whether four types of selection bias in estimates of the effectiveness of prenatal care utilization for improving birthweight occur in a population of economically disadvantaged women. METHODS: We categorized adequacy of prenatal care use using the Adequacy of Prenatal Care Utilization Index (APNCU) and the Revised-GINDEX for 142,381 Medicaid recipients who gave birth to a live, singleton infant in Washington State (1994-1998). Multinomial logistic regression was used to model categories of adequacy of prenatal care use as functions of variables chosen to indicate high- or low-risk status. A series of linear regression models were estimated to quantify the magnitude and direction of any bias in the effects of prenatal care on birthweight that could be attributed to accounting for each risk covariate. Results were examined for patterns of risk, prenatal care use, and estimation bias equated with the four selection processes. RESULTS: We found modest evidence of adverse, favorable, confidence, and estrangement selection biases. The overriding effect, relative to low prenatal care use, was overestimation of the adequate care coefficient by 8.68 g with the APNCU, and underestimation by 3.36 g with the R-GINDEX because of competing confidence and estrangement selection biases. Relative to intensive use, the effect of adequate care on birthweight was underestimated (17.58 g with the APNCU; 13.34 g with the R-GINDEX) because of adverse selection bias and a small countervailing favorable selection process. CONCLUSIONS: The underestimation of birthweight associated with prenatal care noted in prior studies appears to result from multiple selection processes working in different directions. Understanding selection processes can help the assessment of the contribution of prenatal care to birth outcomes and development of appropriate programs and policies.

Adult↗

PubMedDate not supplied

Thinking outside the box: prenatal care and the call for a prenatal advance directive.

The concept of advance directives is well-known in the care of adults as a mechanism for choosing in advance the extent of medical interventions desired in clinical situations, particularly life-extending interventions such as ventilation support and drugs to maintain cardiopulmonary status. Infants born extremely prematurely often require life-supporting measures for which their parents or guardians report feeling unprepared to make decisions about. Current prenatal care does not include an educational component that teaches women about the length of gestation needed for a healthy viability, survivorship, and outcome without major impairment. Women who go into preterm labor are asked to make immediate decisions during times of crisis without any formal education base for this decision making. Feminist ethics (the philosophical stance that articulates that women's moral experience is worthy of respect and disallows women's subordination) (Becker LB, Becker CB, eds. Feminist ethics. In: Encyclopedia of Ethics. New York: Routledge Press; 2001) requires that healthcare decisions be based on education, context, and particular situations. The purpose of this article is to examine the current content of typical prenatal care and education and to suggest an additional educational component to prenatal care-education of women about infant viability and the planning of future decisions if a nonviable or critically ill newborn is delivered. A prenatal discussion and parental/family directive is suggested.

Advance Directives↗

PubMed1996

The relationship between characteristics of obstetrician-gynecologists and rates of recommended prenatal care screening tests.

OBJECTIVE: To examine the relationship between characteristics of obstetrician-gynecologists and rates of recommended prenatal care screening tests. DESIGN: Retrospective review of prenatal care records. SETTING: Prudential HealthCare. PARTICIPANTS: Enrolled women (2184) between 14 to 47 years of age who delivered a live birth in 1992, and saw an obstetrics and gynecology (OB/GYN) physician for prenatal care. MAIN OUTCOME MEASURE: Receipt of routine prenatal care screening tests. RESULTS: Pregnant women received most of the recommended prenatal care screening tests more than 90% of the time, with the exception of urinalysis (68.3%), alphafetoprotein (72.1%), glucose challenge (87.5%), and repeat haemoglobin/hematocrit (71.0%). Rates of receiving recommended screening tests varied by obstetrician's gender and number of years since medical school graduation. Women were more likely to receive an antibody test if they saw a female rather than a male obstetrician (p < 0.05), and more likely to receive syphilis serology, rubella, glucose challenge and repeat hemoglobin and/or hematocrit tests if they saw an obstetrician who graduated from medical school within the past 30 years (1965 or later), rather than an obstetrician who graduated more than 30 years ago (p < 0.05). CONCLUSION: The receipt of prenatal care screening tests varies by characteristics of OB/GYN physicians. The results of this study suggest that targeting educational opportunities to OB/GYN physicians whose year of medical school graduation is 1965 or earlier may improve rates of recommended prenatal screening tests.

Adolescent↗

PubMed2006

Prenatal care: the patient's perspective. A qualitative study.

OBJECTIVES: To investigate the subjective experiences and perceptions of the prenatal care system for women following a prenatal diagnosis and to assess the factors related to dissatisfaction with medical treatment. METHODS: Data derived from a follow-up investigation in fifty women following a prenatal diagnosis is presented. Women were asked to give written comments concerning their feelings and experiences during their time at the prenatal care unit. A qualitative content analysis was performed in order to examine the patients' perceptions and expectations of the prenatal care management and to seek potential associations of certain attitudes with socio-demographic, clinical, or psychological characteristics. Womens' comments were coded within established categories including 'satisfaction', 'dissatisfaction' and 'communicated emotionality'. RESULTS: A high proportion of women were found to be dissatisfied with the physicians' attitudes (42%), the amount of information provided (46%), and medical staffs' attitudes (30%). One criticism, in particular, concerned a lack of communication skills in doctors and medical staff members. Forty-eight percent of our study population mentioned that they had benefited from psychological support. 'Nullipara' was the only variable associated with dissatisfaction with the received prenatal care. CONCLUSIONS: The results of the study suggest that the high degree of discontent found in prenatal care patients could at least in some part be alleviated by implementation of communication training and supervision services for prenatal care workers. Moreover, nullipara may constitute a particular vulnerable subgroup that may need special attention and support. However, given the qualitative nature of our study, our results warrant replication in further empirically based research.

Adaptation, Psychological↗

PubMed1989

[A model for organization of prenatal care].

The article presents a model for organized prenatal care in a district of 45,000 people. General practitioners, midwives and an obstetrician share responsibility for pregnant women in the region. The general practitioners have primary responsibility for the prenatal care, but all the pregnant women are offered consultation with the midwife twice and with the obstetrician once during the pregnancy. The midwives give general information on pregnancy and birth, and also take part in the ultrasonographic screening program. The obstetrician provides individual care to women with risk pregnancies, or in the event of complications. This system offers similar prenatal care to all pregnant women in the area without interfering with their personal wishes.

Female↗

PubMed1994

State-specific trends among women who did not receive prenatal care--United States, 1980-1992.

Lack of prenatal care is strongly associated with an increased risk for low birthweight (< 2500 g [< 5 lbs 8 oz] at birth) infants, preterm delivery, and maternal and infant mortality (1). From 1980 through 1992, the nationally aggregated percentage of pregnant women who did not receive prenatal care increased by 31%--from 1.3% to 1.7% (2,3). Because nationally aggregated data can obscure variations among states, CDC analyzed state-specific data derived from birth certificates for 1980-1992 to examine trends among women who did not receive prenatal care. This report summarizes the findings of the analysis.

Female↗

PubMed2000

Exploration of facilitators and barriers to prenatal care among military women.

Early and regular prenatal care has been shown to decrease the incidence of adverse pregnancy outcomes; however, little research has examined it experientially from the mother's perspective. The purpose of this qualitative study was to explore the experience of prenatal care from the military mother's perspective. Using purposive sampling, 16 women who had recently given birth were interviewed. The data were analyzed using a qualitative descriptive research methodology to elicit categories of substantive concepts, ideas, or themes. Data explored in this study included availability, use and satisfaction with prenatal care services, and barriers, preferences, and recommendations.

Female↗

PubMed2001

Lack of prenatal care in two different societies living in the same region and sharing the same medical facilities.

We set out to examine pregnancy outcome of women who utilised prenatal care facilities and those who did not, within two different ethnic groups living in the same region and sharing basically the same medical facilities. The study population consisted of all singleton deliveries occurring between the years 1990-97 (n = 78 955). The analysis was based on a comparison of births to Jewish and Bedouin women who did not have prenatal care (defined as less than three visits at any prenatal care facility during the pregnancy) and those who had prenatal care (at least three visits at any prenatal care facility). Lack of prenatal care was found in 0.98% of the Jewish mothers and in 20.95% of the Bedouin women. Bedouin women receiving prenatal care had significantly higher rates of perinatal mortality (OR = 1.8, 95% CI 1.6-2.2; P < 0.001) and newborns weighing less than 2500 g (OR = 1.2, 95% CI 1.2-1.3; P < 0.001) compared to their Jewish counterparts. However, in the comparison of women lacking prenatal care, no statistically significant differences were found between the groups with regard to those variables. In spite of the overwhelming cultural and socioeconomic differences between these societies, lack of prenatal care crossed social borders and a similar poor pregnancy outcome was found to be common in the two groups. Attempts should be made in order to remove barriers to prenatal care and to increase adequate utilisation of prenatal care in all societies in general and in ethnic minorities in particular.

Journal Article↗

PubMed1996

[Prenatal care of women delivering in the Vaud canton: retrospective study of 854 cases].

The association between prenatal care and infant health has been shown in many studies. Therefore, accurate information on prenatal care is required to assess the organization of preventive measures aiming at a reducing in neonatal mortality any morbidity. We retrospectively collected data on 854 pregnancies. According to a classification scheme developed by Kessner, 61.6% of women had access to adequate prenatal care. Overall, the proportion of adequate prenatal care was lower among multiparas, and in this subgroup we found a lower rate for women with base line insurance. In the primiparas subgroup we found a lower rate of adequate prenatal care for foreigners, women under 20 years or unmarried mothers, and for women without professional activity during pregnancy, besides preterm birth was more frequent amongst women in the group of prenatal care qualified as intermediate or inadequate. The frequency of pregnancy visits and the Kessner index are discussed in a literature review. The association between socio-economic indicators and prenatal care was unexpected considering the overall wealth of Switzerland. With a 6.8% infant mortality registered in 1989, this country can be considered to have one of the lowest rates in the world. These findings nevertheless suggest the way to possible additional gains by interventions targeted to specific socio-economic groups.

Adult↗

PubMed2006

Disparity in prenatal care among women of colour in the USA.

OBJECTIVE: To describe the disparity in prenatal care among women of colour in timing of initiation of prenatal care and total number of prenatal visits. DESIGN: A retrospective, descriptive design. SETTING: A large, urban university midwifery faculty practice. PARTICIPANTS: 439 healthy women at term (37-42 weeks gestation) with a vertex singleton pregnancy, and an essentially uncomplicated prenatal course. One clinic, the university facility, provided full-scope services. The other four community clinics, all outside the university in the larger metropolitan area, were designed to provide care to low-, under-, and uninsured pregnant women. MEASUREMENTS: Timing of initiation of prenatal care and total number of prenatal visits were examined in relation to demographic variables, including race, education, age, marital status, method of payment and clinic sites. FINDINGS: Significant differences in initiation of prenatal care and total number of prenatal visits were documented. The non-Hispanic white women at the university hospital clinic, with high school or college degrees and insurance or Medicaid, were more likely to visit prenatal clinics. Examination of association between timing of initiation of prenatal care and demographic variables showed significant differences in race and education. KEY CONCLUSIONS: This study reflects the difficulty in access to care faced by women of colour. When comparing 1997 national survey findings with those of a 2001 study, about 40% of the 50 States and the District of Columbia showed an increase in the frequency of women receiving late care or no care; additionally, a disparity in access to prenatal care between non-Hispanic white and non-white women was noted in most of these areas. IMPLICATIONS FOR PRACTICE: The number of births to women of colour delivered by midwives has rapidly increased in recent years. Also, the numbers of babies born to women of colour is anticipated to surpass 50% in the next few decades. Considering the increased proportion of births to women of colour, special attention to promote early prenatal care for these populations is needed. Recruitment and retention efforts for non-white midwives, regular education for cultural competence of midwives, and provision of culturally and linguistically appropriate care for women of colour should be considered.

Adult↗

PubMed2002

Timing of prenatal care initiation and risk of congenital malformations.

BACKGROUND: Although previous studies provide some evidence that timing of prenatal care initiation is associated with risks of congenital malformation, the issue has not previously been examined in depth. This study uses data from a large population-based registry to explore the association of timing of prenatal care initiation with risks of selected congenital malformation phenotypes. METHODS: Data on cases were grouped according to four-digit malformation codes of the International Classification of Diseases, Ninth Revision (ICD-9). A randomly selected group of 10,000 nonmalformed deliveries served as the comparison group. Information on month of initiation of prenatal care (categorized as during months 1-3 of gestation, months 4-7, or after month 7) and other maternal characteristics were derived from vital statistics data. RESULTS: Among the 176 four-digit ICD groupings, 67 had an adjusted odds ratio for at least one of the two prenatal care categories that was either < or = 0.67 or > or = 1.50. Later prenatal care initiation was associated with risk > or = 1.50 for most groups. Later care was associated with risk < or = 0.67 for only two groups, and the effects were imprecise. Statistical interaction between parity and prenatal care was indicated for 13 groups (P < 0.10). Risks among women with no previous pregnancy tended to increase with later prenatal care initiation; risks among parous women tended to be somewhat weaker. In general, associations applied to a wide range of malformation groups. CONCLUSIONS: This is the first large-scale study of the association of timing of prenatal care initiation and congenital malformation risks. Further defining the phenomena that surround prenatal care as a marker may help clarify the etiologies of a variety of malformations.

Congenital Abnormalities↗

PubMed2002

Factors influencing the access to prenatal care by Hispanic pregnant women.

PURPOSE: To explore factors influencing the access to prenatal care among Hispanic pregnant women living in the United States. DATA SOURCES: A convenience sample of 46 Hispanic migrant pregnant women was interviewed over a 12-month period using a set of five open-ended questions. CONCLUSIONS: The ability of the health care providers to communicate in Spanish, as well as the availability of culturally sensitive prenatal care were the main factors influencing the willingness of Hispanic women to access to prenatal care. IMPLICATIONS FOR PRACTICE: With the Hispanic population increasing in the United States, there is a need to provide culturally appropriate health care for that population; prenatal care is one of the areas of health care in demand. This study supports the findings in the literature and provides nurse practitioners a deeper understanding of the needs of Hispanic women needing prenatal care.

Adolescent↗

PubMed1998

The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States.

OBJECTIVE: To explore the association between adequacy of prenatal care utilization and subsequent pediatric care utilization. DESIGN: A longitudinal follow-up of a nationally representative sample of infants born in 1988. PARTICIPANTS: Nine thousand four hundred forty women who had a live birth in 1988, and whose child was alive at the time of interview, and 8285 women from the original sample who were reinterviewed in 1991. MAIN OUTCOME MEASURE: There were four outcome measures: number of well-child visits; adequate immunization for diphtheria, tetanus, and pertussis; adequate immunization for polio; and continuity of a regular source of care, as measured by the number of sites for pediatric care. RESULTS: Children whose mothers had less than adequate prenatal care utilization had significantly fewer well-child visits, and were significantly less likely to have adequate immunizations, even after income, health insurance coverage, content of prenatal care, wantedness of child, sites of prenatal and pediatric care, and maternal and pregnancy risk characteristics were taken into account. Less than adequate prenatal care utilization was not associated with having more than one pediatric care site. CONCLUSIONS: Prenatal care utilization can be used to identify and target interventions to women who are at risk for not obtaining well-child care or complete immunizations for their children.

Child Health Services↗

PubMed1997

An assessment of the use and impact of ancillary prenatal care services to Medicaid women in managed care.

OBJECTIVES: Managed care plans under Medicaid are becoming a usual source of care for low-income pregnant women. This study describes an ancillary prenatal care service intervention developed by one managed care organization (MCO) for Medicaid-enrolled women, assesses the extent to which the intervention services were used, and appraises the influence of the intervention on prenatal care participation. METHOD: There were 226 intervention and 258 control women with a single live birth delivered between 28 and 44 weeks gestation who (1) were enrolled in the MCO's Medicaid program, (2) were high-risk based on a prenatal risk assessment, and (3) started prenatal care prior to 26 weeks gestation. Less than adequate and intensive prenatal care utilization were chosen as intervention outcomes measures. RESULTS: Family planning, a 2-month postpartum baby visit, a maternal postpartum visit, and a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) referral were among the most self-selected intervention services for this population; home health aide and breast-feeding support were the least requested services. Over 90% of those needing family planning or breast-feeding services received the services, while over 20% of the intervention group refused child care, food assistance and family violence referrals, and home health aide and smoking cessation services. The intervention group had a significantly lower risk of less than adequate utilization of prenatal care (OR = .32; 95% CI: 0.17-0.60) and was more likely to have an intensive number of prenatal care visits (OR = 1.61; 95% CI: 1.05-2.48). CONCLUSIONS: The ability of managed care organizations to provide ongoing prenatal care to Medicaid populations in a cost-effective manner depends partly on their development of packages of prenatal services that foster positive preventive health care utilization behaviors and good pregnancy outcomes. The results of this project suggest that the intervention was beneficial in the area of improving utilization of prenatal care.

Adolescent↗

PubMedDate not supplied

Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.

Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of the research controversies and challenges facing investigators and advocates who seek to establish the value of prenatal care. In addition, the authors recommend directions for future research to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.

Evidence-Based Medicine↗

PubMed2003

Utilization of prenatal care in poorer and wealthier urban neighbourhoods in Turkey.

BACKGROUND: The objectives of this study are to identify the individual- and neighbourhood-level determinants of utilization of prenatal care, and to identify self-reported reasons for not receiving prenatal care in Turkey. METHODS: A household-based cluster sample of 1249 women who had a child less than two years old were interviewed in five Turkish cities. Multilevel regression analysis was run to predict the influences of individual- and neighbourhood-level characteristics on utilization of prenatal care. RESULTS: Utilization of prenatal care and the quality of the care received were found to be significantly lower in poorer neighbourhoods. Using multilevel regression analysis (two levels), educational level, income, parity and having health insurance were found to be individual-level determinants, while quality of care offered and stability of the local population were found to be neighbourhood-level determinants of utilization of prenatal care. The most frequent self-reported reason for receiving no prenatal care was 'not having any complaint', and the second was 'insufficient financial resources'. CONCLUSION: There was a big difference between poor and wealthy neighbourhoods in utilization of prenatal care. This difference was partly due to a contextual effect of neighbourhood status; but mostly due to individual-level variables. Improving the quality of prenatal care may increase not only the benefits of prenatal care, but also its utilization, especially in the public sector. Health and social policies have to take into account diversity among individuals and neighbourhoods in the course of efforts to improve service quality.

Adolescent↗

PubMedDate not supplied

Mexican-Americans' use of prenatal care and its relationship to maternal risk factors and pregnancy outcome.

We evaluate the adequacy of prenatal care use and the association of use to a series of maternal risk factors and pregnancy outcomes, such as low birthweight, preterm delivery, and macrosomia in both Mexican-Americans and non-Hispanic whites in Arizona. The data came from all live-birth certificates from 1986 and 1987 for a total of 101,202 (26,826 Mexican-Americans). We evaluated the adequacy of prenatal care using a redesigned index that accounts for three factors: the month when prenatal care began, the number of prenatal care visits, and the duration of pregnancy. From this index we identified six prenatal care groups: intensive, adequate, intermediate, inadequate, no-care, and missing/unknown. Overall, we observed ethnic differences in patterns of prenatal care use, social profiles, and medical risk factors. Non-Hispanic whites, compared to Mexican-Americans, showed a greater risk for low birthweight and preterm delivery in those groups receiving poor prenatal care versus those who received adequate care. Within Mexican-Americans the risk of low birthweight was not the same for all subgroups. A higher overall prevalence of preterm delivery and macrosomia in comparison to low birthweight occurred in Mexican-Americans. We discuss the implications of the results for the identification, interpretation, evaluation, and public health significance of perinatal health problems of Mexican-Americans.

Adolescent↗