Decreasing the Prematurity Rate

Abstract

INTRODUCTION: Early prenatal care (PNC) has been shown to improve pregnancy outcomes, we want to determine the magnitude of impact early PNC could have on the percentage of preterm birth. METHODS: A retrospective cohort of births 24 to 42 weeks was created from 2013 birth certificates. Multiple gestations, preterm inductions and anomalous pregnancies were excluded. We determined who had early (<20 weeks) or late (>20 weeks) PNC for women delivering preterm (24–36 weeks) and term (37–42 weeks). For maximal effect that early PNC could have on the prematurity rate, we assumed all patients with late PNC who delivered preterm would have been eligible for progesterone (vaginal or intramuscular). Based on previous data, we used a 33% preterm birth (PTB) reduction. Reduction in PTB percentage were calculated. Lifetime cost savings for prematurity were calculated using previously published estimates. Student's t test and chi-squared analysis were utilized. RESULTS: The late PNC group had 31,469 preterm births. A maximal reduction of 10,384 PTBs would occur with early PNC and progesterone use. The PTB percentage would drop from 11.14% to 10.88%. Of those who presented late and delivered prematurely, 65% had Medicaid. Lifetime cost savings of decreased prematurity would be $88.9 million. CONCLUSION: A small drop from 11.14% to 10.88% in the PTB percentage is the maximal decrease in prematurity with early PNC. Despite a limited decrease in the PTB percentage, the savings are considerable. Early PNC is desirable however it is not a panacea for PTB in the US, other interventions need to be identified and developed.