602 THE EFFECT OF PRENATAL CARE UPON BIRTH WEIGHT SPECIFIC OUTCOME

Abstract

It is generally accepted that variations in birth weight-specific mortality rates (BWSMR) are closely related to the nature and quality of medical care provided the neonate once born. However, the effect of prenatal care on BWSMR has not been well explored. We studied linked birth/neonatal death vital statistics files for the City of Boston for the years 1975–79. Logistic models were used to assess the influence of prenatal care adjusting for race, gestational age, maternal age, education, and family income. For the 329 deaths and 68,842 births analyzed, prenatal care was significantly related to overall neonatal survival (p < .001). However, its effect upon BWSMR was not uniformly significant: The data suggest that prenatal care does not greatly influence BWSMR at low birth weights. However, the adequacy of prenatal care services appears to strongly affect survival at birth weights above 2500g. Alterations in access to prenatal care could therefore influence both the distribution of low birth weight (LBW) births and the BWSMR of non-LBW neonates.