Trends and Racial/Ethnic Disparities in Prenatal Care (PNC) Use from 2016 to 2021 in the United States.

Abstract

To investigate the trends and racial/ethnic disparities in adequate prenatal care (PNC) use in the USA. A repeated cross-sectional study was conducted using May 2016-May 2021 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A primary outcome was the Kotelchuck index, a measure of the adequacy of PNC use, and the year was a key independent variable. Multinomial and binary logistic regression analyses were performed to examine PNC utilization using multiple imputations with chained equations. Among the 190,262 pregnant individuals, adequate PNC use was largely consistent from 2016 to 2019. However, there was an immediate drop from 77.4-78.3% between 2016 and 2019 to 75.2% in 2020 and 75.8% in 2021. Conversely, both intermediate and inadequate PNC use tended to increase in 2020 and 2021. Adequate PNC use, when compared to inadequate use, showed significantly lower odds in 2020 (adjusted Odds Ratio [aOR] 0.87, 95% CI 0.78-0.96; p = 0.009) and 2021 (aOR 0.87, 95% CI 0.77-0.99; p = 0.033) than in 2016. Notably, Hispanic participants experienced substantial impacts (aOR 0.75, 95% CI 0.64-0.88; p = 0.001 in 2020 and aOR 0.72, 95% CI 0.59-0.89; p = 0.002 in 2021). While adequate PNC use was a steady, slightly upward trend before 2020, it had a steep decline afterward. It is worth noting that Hispanic individuals were severely affected. Targeted interventions or policies to address barriers to PNC and foster equitable and sustainable care models are required.