Adequate Prenatal Care Utilization Research Articles

Biopsychosocial contexts of timely and adequate prenatal care utilization among women with criminal legal involvement and opioid use disorder

ObjectivePregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU).MethodsAnalyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ2, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression.ResultsAmong 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07–5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01–3.41), having stable housing (aOR 2.49, 95% CI 1.41–4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54–10.7) or community supervision (aOR 2.05, 95% CI 1.16–3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27–3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45–7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07–1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22–3.76), having stable housing (aOR 1.94, 95% CI 1.06–3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19–8.15).ConclusionWhile not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).

The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago.

To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship. We performed multilevel logistic regression analyses on a 2013-2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income. Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization. Spatial polarization of race and income in urban African-American and non-Latinx white women's residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.

Adequacy of Prenatal Care Utilization in a Pathways Community HUB Model Program: Results of a Propensity Score Matching Analysis.

The THRIVE (Toward Health Resiliency and Infant Vitality & Equity) program aims to reduce racial disparities in birth outcomes by addressing individual risks and social determinants of health using the Pathways Community HUB model. This study examines (1) racial disparities among THRIVE participants and propensity score matched (PSM) comparisons in adequacy of prenatal care, and whether THRIVE participation (2) attenuates such disparities, and (3) improves odds of having adequate prenatal care. Birth certificate and Care Coordination Systems client data were merged for analysis. PSM was employed for 1:1 matching per birth year (2017-2020) and race for participating and non-participating first-time births in Stark County, Ohio. Additional matching variables were age, marital status, education attainment, birth quarter, census tract poverty rate, and Women Infant & Children (WIC) enrollment. Logistic regression assessed racial differences in adequate prenatal care utilization (APNCU) and examined differences between the intervention and comparison groups on APNCU. THRIVE participants averaged more prenatal care visits and had a higher percentage of adequate care utilization than the comparison group. THRIVE program participation, educational attainment, and WIC enrollment were associated with higher odds of adequate prenatal care utilization (OR 4.74; 95% CI 2.62, 8.57). Race was not significant for APNCU. Although accessing and maintaining prenatal care is only one aspect of improving birth outcomes, the findings contribute to the understanding of the effects of the program of interest and other similar programs on factors which may promote desired birth outcomes in high-risk populations.

Predictors of Timely Prenatal Care Initiation and Adequate Utilization in a Sample of Late Adolescent Texas Latinas.

Little is known of late adolescent Texas Latinas' prenatal care perceptions or how these perceptions predict timely prenatal care initiation or adequate utilization. Hence, the purpose of this study is to describe and compare these perceptions between participants with timely versus late prenatal care initiation and adequate, intermediate, and inadequate prenatal care utilization; and to determine predictors of timely prenatal care initiation and adequate utilization. Fifty-four postpartum Latinas were recruited through social media. Eligibility criteria were 18 to 21 years old, Texas-born, primiparous, uncomplicated pregnancy/delivery, and English literate. Prenatal care perceptions were measured with the Revised Better Babies Survey and Access Barriers to Care Index. Participants had favorable views of prenatal care benefits; however, not living with the baby's father predicted inadequate prenatal care, Wald χ2(1) = 4.93, p = .026. Perceived benefits of timely and adequate prenatal care predicted timely prenatal care initiation, χ2(1) = 7.47, p = .006. Self-reported depression during pregnancy predicted timely entry into prenatal care, χ2(1) = 4.73, p = .03. Participants' positive prenatal care perceptions did not predict adequate prenatal care utilization, indicating that barriers serve as powerful obstacles in late adolescent Texas Latinas.

Inadequate Utilization of Prenatal Care Services, Socioeconomic Status, and Educational Attainment Are Associated with Low Birth Weight in Zimbabwe.

Globally, low birth weight (LBW) remains a leading cause of neonatal and infant mortality and poses significant challenges toward the progress of achieving infant mortality-related goals. Experience from developed countries shows that two major causes of LBW (premature delivery and intrauterine growth restriction) can be averted to a great extent by adequate utilization of maternal health-care services, during pregnancy. In this study, we attempt to measure the prevalence of LBW in Zimbabwe and explore the association between adequate utilization of prenatal care (PNC) services and LBW in Zimbabwe. We also explore other possible associations with LBW. This study was based on nationally representative, cross-sectional data from Multiple Indicator Cluster Survey round 5, conducted in 2014. Participants included 3,221 mothers from both rural and urban areas. The participants were selected regardless of their current pregnancy status. Sample characteristics were presented using descriptive statistics. Association between utilization status of ANC and LBW was measured by chi-square (bivariate) test and logistic regression methods. Prevalence of LBW was 12.8%. There was 11% reduction in the odds of having LBW babies for participants from urban area when compared with rural area (AOR = 0.897; 95% CI = 0.707-1.138). When compared to women with higher education, those having primary/below primary and secondary level qualification had higher odds of experiencing LBW babies by 73 and 56%, respectively. Participants who had less than four PNC/ANC visits had 34% higher odds (AOR = 1.340; 95% CI = 1.065-1.685) than those with at least four visits, and those who had given birth more than once, had 38% lower odds (AOR = 0.620; 95% CI = 0.493-0.780) of giving birth to LBW babies when compared to those who had given birth only once. The findings of this study have programmatic and policy implications for low-resource nations and suggest that promoting access to ANC services especially in the rural areas is likely to reduce prevalence of LBW in Zimbabwe. This is important as LBW babies consume lot of health resources per se and not only in terms of hospitalization but also in terms of outpatient and physician visits during the first year of their life.

Disparities in Prenatal Care Utilization Among U.S. Versus Foreign-Born Women with Chronic Conditions.

We examined disparities in prenatal care utilization (PNCU) among U.S. and foreign-born women with chronic conditions. We performed a cross-sectional analyses using data from 2011 to 2012 National Center for Health Statistics Natality Files (n=6,644,577) to examine the association between maternal nativity (U.S. vs. foreign-born), presence of a chronic condition (diabetes or hypertensive disorder) and PNCU. After adjustment for selected maternal characteristics, overall and among those with chronic conditions, foreign-born women reported significantly lower odds of intensive and adequate PNCU and higher odds of intermediate and inadequate PNCU than U.S.-born women. Few differences in report of no care were found by maternal nativity. These findings suggest that foreign-born women may be receiving some form of prenatal care, but adequacy of care is likely to be lower compared to U.S.-born counterparts, even among those with chronic conditions.

Adequacy of prenatal care and its association with pregnancy outcomes: A comparison of indices in Tabriz, Iran

Introduction: Improving of mother and child health is one of the most important and essential roles of public health agencies and millennium development goals. The aim of this study was to determine rates of prenatal care (PNC) utilization in Tabriz, Iran, from 1994-2013 and compare the two most commonly used models of PNC utilized in determining the proportion of the pregnant woman receiving inadequate PNC and comparing use of two indices. Methods: In this study, we conducted a descriptive cross-sectional study of 2834 women having a health record in care center of the rural region in Tabriz for 20 years. We used questioner that validated in the study Jabbari et al. for obtaining data. Random sampling quotes were done in 3 times during the years 1994-2013. Results: We found that 53% of mothers received adequate care by adequate PNC utilization (APNCU) index, but 17% by revised-GINDEX index but the most important objective of our study was identifying the relationship between adequacy of PNC and pregnancy outcome. On the other hand, the study indicated that between inadequate care and low birth weight (LBW), mother weight gaining, birth height exists significant association, but there is no meaningful correlation between birth weight and adequacy of care (P < 0.05). Conclusion: The study analyzed the effect of PNC utilization on birth outcomes and suggested that PNC decrease LBW through both increasing gestational age as well as improving fetal growth at the same time it improves birth height and mother weight gaining. All findings of this study emphasize the need for health policies to improve utilization and access PNC.

Barriers to Adequate Prenatal Care Utilization in American Samoa

The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007-2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007-2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population.

Impact of Prenatal Care Utilization on Infant Care Practices in Nepal: a National Representative Cross-sectional Survey

This study aimed to examine the utilization of prenatal care and its association with infant care practices using a nationally representative sample of Nepalese mothers and children. The study data was based on the 2006 Nepal Demographic and Health Survey which comprised of women age 15-49 years old who had delivered within three years prior to the survey (N = 4,136). A multilevel logistic regression model was fitted to assess the influence of prenatal care utilization on several indicators of infant care. Neonatal mortality is still high in Nepal (46 per 1,000 live births). After taking into account several maternal and child characteristics, children of mothers with no prenatal care were at increased risk of neonatal death (OR = 2.03, 95 % CI = 1.28-3.23). Compared to women with no prenatal care, those with more than three visits were more likely to immunize their children (OR = 2.66, 95 % CI = 2.10-3.36) and more likely to initiate breastfeeding within 1 h after birth (OR = 1.25, 95 % CI = 1.02-1.54). Having skilled attendants at prenatal care and at birth was also associated with better infant care practices. Neonatal mortality is still high in Nepal. Adequate prenatal care utilization may represent a key preventative strategy, which, in the present study, was associated with improvement in neonatal mortality, higher likelihood of having immunization, and initiation of breastfeeding within 1 h after birth. Public health awareness programs and interventions are needed in Nepal to increase the utilization of prenatal care as well as delivery assisted by skilled attendants.

Assessment of Pregnancy Cigarette Smoking and Factors That Predict Denial

To determine rates of pregnancy smoking concealment compared to behavioral observation and to identify factors predicting untruthful denial. Review of 843 delivery charts. Based on observation during delivery hospitalization, 8% of smokers denied hospital admission, 16% denied throughout prenatal care. Compared with those admitting smoking, false deniers had higher levels of education, incomes and adequate prenatal care utilization; and were less likely to have drug use, STDs, or hepatitis C. Observation was a valid tool for assessing smoking status. Typical concealers were those considered lower risk, increasing the chance they would go undetected as smokers.

Does underutilization of prenatal care explain the excess risk for stillbirth among women with migration background in Germany?

To explore the role of utilization of prenatal care on the risk for stillbirth among women with migration background in Germany by comparing stillbirth rates of women from different origins characterized by adequate and inadequate utilization of prenatal care to German women with adequate utilization of care. Retrospective cohort study. Lower Saxony, Germany. Singletons born in 1990, 1995 and 1999 (n = 182,444). We analyzed perinatal data collected by obstetricians and midwives prospectively during pregnancy and after birth. The Adequacy of Prenatal Care Utilization Index was applied. Chi-squared tests and bivariate and multivariable logistic regression models were used. Stillbirth rates. In crude analyses, inadequate utilization of prenatal care (OR = 1.86, 95% CI 1.52, 2.28), and origin from Central and Eastern Europe (OR = 2.05, 95% CI 1.63, 2.58), the Mediterranean (OR = 1.77, 95% CI 1.38, 2.65), the Middle East (OR = 2.63, 95% CI 2.24, 3.09) and other countries (OR = 1.79, 95% CI 1.10, 2.89) were related to stillbirths. After adjustment for age, parity, smoking, inter-pregnancy interval, employment status and year of observation, compared to Germans with adequate utilization of prenatal care, women with adequate utilization of care from Central and Eastern Europe (OR = 1.74, 95% CI 1.33, 2.29) and the Middle East (OR = 1.98, 95% CI 1.64, 2.39) and women with inadequate utilization of prenatal care from the Mediterranean (OR = 3.00, 95% CI 1.71, 5.26) were at higher risk for stillbirths. There are inconsistent relation patterns between stillbirth, area of origin and utilization of prenatal care. Among women from the Mediterranean, increasing utilization of prenatal care may result in lower stillbirth rates.

Determinants of Inadequate Prenatal Care Utilization by African American Women

A convenience sample of city-dwelling African American women (n=246) was interviewed during each woman's postpartum stay at one of five hospitals in Washington, D.C. to determine their perceptions of factors influencing their prenatal care utilization. The Kotelchuck Adequacy of Prenatal Care Utilization Index was used to classify prenatal care utilization as either adequate (Adequate Plus and Adequate groups combined) or inadequate (Intermediate and Inadequate groups combined). Of the 246 women studied, 40% (99) had adequate prenatal care utilization. Using Classification and Regression Trees analysis, the following risk groups for inadequate prenatal care utilization were identified: women who reported psychosocial problems as barriers and who were not participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) (percent adequate=8.8); women who reported psychosocial problems as barriers, were participants of the WIC program, and reported substance use (percent adequate=13.8); and women who reported psychosocial problems as barriers, were participants of the WIC program, denied substance use, and reported childcare problems as barriers (percent adequate=20.0).

Uso do índice de Kotelchuck modificado na avaliação da assistência pré-natal e sua relação com as características maternas e o peso do recém-nascido no Município do Rio de Janeiro

The Kotelchuck index (KI) was modified and used to evaluate prenatal care provided in the City of Rio de Janeiro, Brazil, in a sample of 9,920 post-partum women following singleton deliveries. Ordinal logistic regression (OLR) and multivariate linear regression (LMR) were used to estimate the importance of demographic, psychosocial, and obstetric factors for modified KI and the effects on birth weight (BW), respectively. Only 38.5% of the sample was classified as having received adequate or intensive prenatal care. After adjusting for other predictors, the explanatory variables for KI were: mother's schooling, living with the newborn's father, attempted abortion, diabetes mellitus, satisfaction with pregnancy, skin color, parity, age, and place of residence. BW was associated with the modified KI, even after controlling for socio-demographic, behavioral, and biological variables. Adequate utilization of prenatal care in the City of Rio de Janeiro contributed to the prevention of low BW, and the mothers who used prenatal services less presented worse conditions in terms of socioeconomic status, schooling, family support, and obstetric risk.

Prenatal Care Utilization Among Low-Income African American Women Prenatal Care

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, &chi2(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.

Perceived impediments to prenatal care among low-income women.

The study describes women's experience with prenatal care, their perceived impediments to care, and compares the impediments cited by the women with levels of care utilization. The sample consisted of 126 African American women. A structured interview and questionnaire were used. The results showed that pregnancy was unplanned in 78.6% of the women, and no one encouraged the women to obtain care in half the cases. Only 50.8% of the women made adequate utilization of prenatal care. The main impediments to care were transportation, long waiting time, having too many other problems, and fear of staff finding out about the women's use of substances. Five of the reported impediments significantly influenced the women's utilization of care. These were: substance abuse, fear of medical examination, the belief that prenatal care is not necessary, already knew of pregnancy, and no babysitter for other children.

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

To explore the association between adequacy of prenatal care utilization and subsequent pediatric care utilization. A longitudinal follow-up of a nationally representative sample of infants born in 1988. 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. 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. 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. 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.

What Component of Prenatal Care Is Responsible for Improved Outcome?

<h3>To the Editor.</h3> —The article by Dr Kogan and colleagues¹attempts to answer an oft-repeated question: What component of prenatal care leads to improved outcome of the newborn? The authors appropriately cite multiple sources that indicate that adequate utilization of prenatal care is associated with improved birth weight and lower risk of preterm delivery. The article suggests that "sufficient health behavior advice" lowers the risk of delivering low-birth-weight infants. Despite the large number of patients surveyed by questionnaire and the appropriate statistical analysis of their study, I am not convinced that any message or teaching, no matter how dynamic or well conceived, has a direct organic impact on the successful outcome of pregnancy. Enthusiasm and effort by obstetricians and related health care providers are, indeed, associated with improved access to the health care system for pregnant women and better outcomes.²However, the variability in training, experience, and other

Pregnancy outcomes among Whites and Filipinos: A paradoxical birth weight-neonatal mortality relationship.

Evidence from the Philippines suggests that, compared to Whites, infants born to Filipino women are more likely to be low birth weight. A paucity of information is available regarding birth outcomes of U.S.-born Filipinos. Using 1979-1987 Hawaii vital record data on single live births to resident mothers, this study compares the maternal characteristics and pregnancy outcomes of White and Filipino mothers, Filipino mothers were significantly more likely to be <18 years of age and single, and have lower educational attainment and less adequate utilization of prenatal care. Significantly higher percentages of very preterm, preterm, very low birth weight, low birth weight, and small for gestational age infants were found for Filipinos. The birth weight-specific neonatal mortality rates for Filipinos compared favorably to Whites except at the high end of the birth weight distribution. After taking into account maternal sociodemographic risk and prenatal care factors in a logistic regression, a significant ethnic difference in low birth weight persisted but was not found for neonatal mortality. These data may suggest that similar neonatal mortality rates among ethnic groups may be possible in the face of persistent birth weight distribution differences and add to the growing evidence that a single standard of low birth weight may be inappropriate as an universal indicator of health status risk in a multi-ethnic population. © 1993 Wiley-Liss, Inc.