Adequate Prenatal Care Research Articles

Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study

A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.

Fatores de risco para óbito perinatal em gestantes de alto risco de um hospital terciário de Curitiba-PR, Brasil: estudo caso-controle

Abstract A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p &lt; 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.

Incentives and Barriers to Receiving Prenatal Care Services in Zahedan, Iran: A Qualitative Study

Background &amp; Aims Providing adequate prenatal care for women can help maintain or improve the health of the mother and fetus. This study aims to identify the incentives and barriers to receiving prenatal care in Zahedan, southeast Iran. Materials &amp; Methods This is a qualitative study using a conventional content analysis approach. Participants were 26 people, including 8 healthcare workers and 18 pregnant women referred to the healthcare centers in 2022 in Zahedan. They were selected by a purposive sampling method and underwent semi-structured in-depth interviews, which continued until the data saturation. Content analysis was carried out along with assessing the validity and reliability of data using Graneheim and Lundman’s four criteria (credibility, dependability, transferability, and confirmability). Results After analysis, 504 codes were obtained, which were reduced to 215 codes, from which 19 sub-categories, 6 sub-themes, and 2 themes of prenatal care barriers and incentives. Conclusion Policymakers and authorities in Zahedan should pay attention to the incentives and barriers to receiving prenatal care identified in this study for developing plans to improve the health of pregnant women in this area.

Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available.

Closure of rural Labor & Delivery (L&D) units can impact timely access to hospital-based obstetrical care. Iowa has lost over a quarter of its L&D units in the previous decade. Assessing the effect of these closures on prenatal care in those rural communities is important to understanding the full effect of unit closures on maternal health care. Using birth certificate data in Iowa from 2017 to 2019, the initiation of prenatal care and adequacy of prenatal visits were assessed for 47 rural counties in Iowa. Of these, 7 experienced a closure of the only L&D unit between 1/1/2018 and 1/1/2019. The impact of these closures is modeled for all birthing parents and compared for Medicaid versus non-Medicaid recipients. All 7 counties that experienced the loss of their only L&D unit continued to have prenatal care services available. Experiencing a closure of an L&D unit was associated with a lower likelihood of overall adequate prenatal care but not significantly associated with a lower rate of first-trimester prenatal care utilization. Among Medicaid recipients of the communities where an L&D unit closed, there was an association of closure with both a lower likelihood of adequate prenatal care and entry to prenatal care after the first trimester. Utilization of prenatal care is lower in rural communities following L&D unit closure, especially among Medicaid recipients. This suggests that the overall maternal health systems were disrupted by the closure of the L&D unit, impacting the utilization of services that remained available to the community.

The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome.

(1) To evaluate the direct (un-mediated) and indirect (mediated) relationship between antenatal exposure to opioid agonist medication as treatment for opioid use disorder (MOUD) and the severity of neonatal opioid withdrawal syndrome (NOWS), and (2) to understand the degree to which mediating factors influence the direct relationship between MOUD exposure and NOWS severity. This cross-sectional study includes data abstracted from the medical records of 1294 opioid-exposed infants (859 MOUD exposed and 435 non-MOUD exposed) born at or admitted to one of 30 US hospitals from July 1, 2016, to June 30, 2017. Regression models and mediation analyses were used to evaluate the relationship between MOUD exposure and NOWS severity (i.e., infant pharmacologic treatment and length of newborn hospital stay (LOS)) to identify potential mediators of this relationship in analyses adjusted for confounding factors. A direct (un-mediated) association was found between antenatal exposure to MOUD and both pharmacologic treatment for NOWS (aOR 2.34; 95%CI 1.74, 3.14) and an increase in LOS (1.73days; 95%CI 0.49, 2.98). Delivery of adequate prenatal care and a reduction in polysubstance exposure were mediators of the relationship between MOUD and NOWS severity and as thus, were indirectly associated with a decrease in both pharmacologic treatment for NOWS and LOS. MOUD exposure is directly associated with NOWS severity. Prenatal care and polysubstance exposure are potential mediators in this relationship. These mediating factors may be targeted to reduce the severity of NOWS while maintaining the important benefits of MOUD during pregnancy.

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.

Proportion and factors associated with Apgar less than 7 in the 5th minute of life: from 1999 to 2019, what has changed?

Although variation between observers in the assessment of the Apgar score, it remains a useful indicator of the general conditions of the newborn. This is a cross-sectional study based on population of live births in Brazil in 1999 and biennium 2018-2019. All declarations of live births (DNV) obtained from the Live Births System database were accessed. Frequencies were compared between groups using Pearson's chi-square test and multivariate logistic regression analysis was performed. A statistical significance level of 0.05 was considered. We included 9.050.521 DNVs in our research. We found that 2,1% of newborns had 5th minute Apgar < 7 in 1999 compared with 0,9% in 2018-2019. Multivariate analysis shows that twins and teenage pregnancy are no longer risk factors. Among risk factors, we observed an increase in prematurity, low birth weight and congenital anomalies. An improvement in maternal markers was observed, especially increase in the number of prenatal consultations and schooling. Such findings demonstrate the importance access and adequate prenatal care and improved socioeconomic conditions as effective strategy to reduce neonatal morbidity and mortality.

Impact of Prenatal Care on Newborn Complications for Infants with Cleft Lip with or Without Cleft Palate.

To determine the association between prenatal care and cleft lip with or without cleft palate (CL ± P) and examine differences in newborn complications among infants diagnosed with CL ± P as a function of prenatal care. Population-based retrospective cohort study. 2018 United States National Vital Statistics System-Natality component (NVSS-N) was used to examine nationwide birth certificate data. 3,414,338 infants from the 2018 National Vital Statistics System, of which 1,699 had CL ± P. Diagnosis of CL ± P and presence of newborn complications as a function of prenatal care. Significant differences were found among various infant- and mother-specific variables when baseline comparisons were made between infants with and without CL ± P. After controlling for baseline differences, results indicated decreased odds of a diagnosis of CL ± P in cases where overall adequate prenatal care was obtained (OR = .841; 95% CI .757, .934), including prenatal care beginning in the 1st trimester (OR = .839; 95% CI .750, .939) and an adequate number of prenatal visits received (OR = .864; 95% CI .764, .976). Of infants with CL ± P, reduced odds of the infant admitted to the neonatal intensive care unit (OR = .777; 95% CI .613, .985) or transferred (OR = .601; 95% CI .407, .888) were apparent when adequate prenatal care was received. Results suggest adequate prenatal care not only reduces the likelihood of CL ± P in infants but may also decrease the severity of negative outcomes in infants diagnosed with CL ± P. These findings emphasize necessity for adequate prenatal care.

Associations of Adverse Childhood Experiences With Pregnancy and Infant Health

Adverse childhood experiences are associated with a host of negative outcomes; however, few have studied cumulative adverse childhood experiences in the context of pregnancy and infant health. This study examines state-level prevalence of adverse childhood experiences and associations with pregnancy- and infant health‒related indicators. The study used 2016-2018 Pregnancy Risk Assessment Monitoring System population-based data from 5 states. Analyses were conducted for individual states and grouped states using similar adverse childhood experience items. Thirteen adverse childhood experience measures were included across 3 domains: abuse, neglect, and household challenges. Adverse childhood experience scores were calculated for the number of adverse childhood experiences experienced (0, 1, 2, ≥3) on the basis of available state measures. Fourteen pregnancy- and infant health‒related indicators were examined, including unwanted pregnancy, adequate prenatal care, experiences during pregnancy (e.g., smoking, abuse, depression), gestational diabetes, hypertensive disorders of pregnancy, birth outcomes (e.g., preterm birth), and breastfeeding. Adjusting for demographics, parity, health insurance status, and educational attainment, prevalence ratios and 95% CIs were calculated to examine the associations between pregnancy- and infant health‒related indicators and adverse childhood experience scores. Over 50% of respondents reported at least 1 adverse childhood experience and 13%-31% reported ≥3 adverse childhood experiences, depending on the state. Significant associations were identified in all adjusted models between adverse childhood experiences and unwanted pregnancy, smoking, physical abuse, and depression during pregnancy. Adverse childhood experiences are associated with risk factors that impact pregnancy and infant health. Preventing and mitigating adverse childhood experiences is an important strategy to improve pregnancy- and infant health‒related indicators.

Psychometric Properties of the Prenatal Opioid Use Perceived Stigma Scale and Its Use in Prenatal Care

ObjectiveTo examine the psychometric properties of the Prenatal Opioid Use Perceived Stigma (POPS) scale and to assess the relationship of POPS scores to adequate prenatal care. DesignProspective cohort study. SettingMedical centers in Alabama, Ohio, and Pennsylvania (N = 4). ParticipantsWomen (N = 127) who took opioids during pregnancy and whose infants participated in the Outcomes of Babies With Opioid Exposure Study. MethodsParticipants reported their perceptions of stigma during pregnancy by responding to the eight items on the POPS scale. We evaluated the instrument’s internal consistency reliability (Cronbach’s alpha), structural validity (factor analysis), and convergent validity (relationship with measures of similar constructs). In addition, to assess construct validity, we used logistic regression to examine the relationship of POPS scores to the receipt of adequate prenatal care. ResultsThe internal consistency of the POPS scale was high (Cronbach’s α = .88), and all item-total correlations were greater than 0.50. The factor analysis confirmed that the items cluster into one factor. Participants who reported greater perceived stigma toward substance users and everyday discrimination in medical settings had higher POPS scores, which supported the convergent validity of the scale. POPS scores were significantly associated with not receiving adequate prenatal care, adjusted OR = 1.47, 95% confidence interval [1.19, 1.83], p < .001. ConclusionThe psychometric testing of the POPS scale provided initial support for the reliability and validity of the instrument. It may be a useful tool with which to assess perceived stigma among women who take opioids, a potential barrier to seeking health care during pregnancy.

Intimate partner violence and barriers to prenatal care

RationalePast research has shown that intimate partner violence (IPV) is associated with less adequate access to prenatal care. However, less is known about why IPV creates challenges for accessing prenatal care, including how IPV is related to unique barriers to prenatal care. ObjectiveThe aim of this study is to examine the association between physical IPV around the time of pregnancy (preconception IPV, prenatal IPV, or both preconception and prenatal IPV) and (1) adequacy of prenatal care, and (2) barriers to prenatal care. MethodsData are from 35 sites (34 states and New York City) from the Pregnancy Risk Assessment Monitoring System (PRAMS) for years 2009–2016 (n = 166,840). Adequacy of prenatal care is examined using multinomial logistic regression and measures of barriers to prenatal care are assessed using negative binomial regression and logistic regression. ResultsThe findings reveal that women with IPV exposure—especially those who experience IPV both before and during pregnancy—are more likely to experience inadequate prenatal care. In addition, women with IPV exposure incur a higher rate of barriers to prenatal care, as well as several specific barriers to prenatal care including not having transportation, not being able to get time off work, being too busy, being unable to find child care, and keeping a pregnancy a secret. ConclusionsConsidering the adverse consequences of both IPV and inadequate access to prenatal care for maternal and child health, the findings of this study highlight the need for public health interventions that both reduce the prevalence of IPV and remove barriers to prenatal care for IPV-exposed women.

Assistência pré-natal entre adolescentes no extremo sul do Brasil: adequação e fatores associados

Abstract Objectives: to evaluate coverage and identify factors associated with adequate prenatal care for adolescent mothers in Rio Grande, Southern Brazil, in a period of 13 years. Methods: over the years 2007, 2010, 2013, 2016 and 2019, a single standardized questionnaire was applied to all mothers at hospital level in this municipality. The outcome consisted of the proportion of puerperae women who started prenatal care in the first trimester and performed 6+ medical visits, completed 2+ HIV, syphilis, and urine tests. Chi-square test was used for proportions, Poisson regression in the multivariate analysis and the prevalence ratio (PR) as measure of effect. Results: among the 12,645 identified mothers, 2,184 (17.3%) were adolescents. Of this total, 35.2% (CI95%= 33.2%-37.2%) had received adequate prenatal care, ranging from 13.8% (10.8%-16.7%) in 2007 to 52,5% (46.8%-58.1%) in 2019. The adjusted analysis showed a higher PR for adequate prenatal care among those of older age and better schooling level, white/brown skin color, with a partner, never had an abortion, were primiparous and non-smokers. Conclusion: there was substantial improvement in coverage of adequate prenatal care over the period studied, but there is still a long way to go. The increase in this coverage depends on reaching adolescents who are younger, less educated, black skin color, living without a partner, multiparous and smokers.

Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil.

The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015. Population-based retrospective cohort of live births (LB) of single pregnancy with 0-27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately. The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added. Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers - low education level and brown or black skin colors - were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.

Adequate Prenatal Care: An Integrative Review.

Prenatal care (PNC) is a core element of preventive care and is vital in identifying and managing conditions that can put the pregnant person and the fetus at risk. National and international guidelines differ in what is considered adequate or quality PNC. Indices of care adequacy rely only on number of attended PNC visits without regard to factors that affect a patient's ability to obtain care or the quality of the care received. This integrative review explored stakeholders' perceptions of adequate and quality PNC. Three electronic databases, CINAHL, PubMed, and Web of Science, were searched to identify original research articles published between 2012 and April 2022. Studies conducted in the United States, published in a peer-reviewed journal, and having a primary focus on the components of adequate or quality PNC were included. The quality of included studies was assessed via the Quality Assessment Tool for Studies with Diverse Designs. Thirteen articles met inclusion criteria. The concepts of adequate or quality PNC were not well defined in the literature. Studies revealed a variety of approaches to assessing individual components of PNC with at times conflicting results of what adequate or quality PNC is. Viewpoints regarding adequacy or quality of PNC were limited by the perceptions and interpretations of individual stakeholders, who included researchers, public health officials, insurers, health care providers, and patients. Ideas of how to redesign PNC were affected by study setting and stakeholders, as well as the emergence and integration of telehealth into PNC delivery. This review is a first step in identifying the gap in the research literature regarding how these concepts are defined and measured. Future research is needed to identify the relevant components of PNC that are necessary to reach consensus definitions of both adequacy and quality of PNC.

Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool.

Patients receiving care at Federally Qualified Health Centers (FQHCs) have low postpartum care attendance. Perinatal morbidity and mortality disproportionately affect patients with low-income and are potentially preventable. The purpose of this study was to develop a clinical decision support tool to identify FQHC patients less likely to return for postpartum care. To accomplish this purpose, we evaluated established predictors and novel risk factors in our patient population. This is a retrospective, secondary data analysis of 50,022 patients who received prenatal care past 24 weeks' gestation in FQHCs between 2012 and 2017. The postpartum visit was defined using Healthcare Effectiveness Data and Information Set measures as early care (birth to 21 days) and later care (21-84 days). Anderson's Behavioral Model for Access to Healthcare guided inclusion of potentially predictive factors. We stratified data by postpartum care attendance, and a final predictive model was selected by model fit statistics and clinical relevance. In our sample, 64% of birthing persons attended postpartum care at FQHCs. Of those who returned for care, 38% returned within 21 days postbirth and 62% returned between 21 and 84 days, with 28% returning for both early and later care. Predictors for postpartum care attendance included maternal age, parity, gestational age at first visit, and number of prenatal care visits. A clinical decision support tool for identifying patients less likely to return for care was created. An easy to implement clinical decision support tool can help identify FQHC patients at risk for postpartum nonattendance. Future interventions to improve adequacy of prenatal care can encourage early entry into prenatal care and sufficient prenatal visits. These efforts may improve postpartum care attendance and maternal health.

Women, Infants, and Children enrollment and pregnancy-related behaviors and outcomes among Medicaid recipients in the United States.

Nearly 40% of pregnant women in 2016 were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior studies have investigated nutritional behaviors among WIC participants and access to WIC breastfeeding counseling services. However, there are no (few?) nationally representative, large-scale analyses of WIC users and pregnancy behaviors. Thus, the present study aims to examine associations between WIC use and select pregnancy outcomes among Medicaid enrollees. We examined pregnancy-related behaviors and outcomes using 2018 U.S. Birth Certificates for Medicaid patients aged 18-45 years (N=1159 263). Outcomes included prenatal care (PNC) adequacy, breastfeeding initiation, cigarette use, and gestational weight gain. Standard binary and multinomial logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). After adjustment, WIC users had statistically significant increased odds of adequate PNC (adjusted OR [AOR]=1.31 [95% CI 1.30, 1.32]), cigarette use (quit smoking during pregnancy 1.09 [1.07, 1.11]; smoked throughout pregnancy 1.16 [1.14, 1.18], and exceeding recommendations of weight gain 1.07 [1.06, 1.08]) compared with non-WIC users. WIC enrollees also experienced decreased odds of breastfeeding initiation (0.85 [0.85, 0.86]) compared with non-WIC users. The study underscores the value of the WIC program in improving access to PNC. Yet, low-income women remain at risk for smoking during pregnancy and exceeding the recommended amount of weight gain. Breastfeeding initiation is lower than anticipated among WIC participants. Additional studies are needed to investigate WIC program efficacy.

The Adequacy of Prenatal Care in Rural Kansas Related to Distance Traveled.

Prenatal care is essential for optimizing the health of a woman and her baby. Multiple factors have created barriers in the access to prenatal care in rural Kansas. Over 120 rural hospitals in the United States have closed since 2010, 5 in Kansas. Seventy-seven of the 105 Kansas counties do not have maternity care services. This study investigated differences in prenatal care received by women in rural Kansas counties related to distance traveled. Differences in timing of initiation of care, number of visits, and services received were compared between two cohorts: those who drove < 19 miles and those who drove ≥ 20 miles for prenatal care. A survey was distributed to women who had delivered a child in the last three years in rural Kansas at participating clinics. Measures of adequacy of prenatal care were determined with questions regarding timing of first prenatal visit, number of prenatal visits, and services received at visits. An index was created using these variables and compared between the two cohorts using two-tailed t-tests for continuous data and chi square analysis for categorical data. Women who traveled ≥ 20 miles for prenatal care received statistically significant less services, and had less prenatal care visits in the second trimester and overall in their pregnancy compared to women who traveled < 19 miles for prenatal care. Rurality did not impact adequacy of prenatal care. Women traveling ≥ 20 miles to receive prenatal care had significantly fewer prenatal visits during their second trimester and overall in pregnancy and self-reported less prenatal care services. These results indicated the importance of lessening barriers to prenatal care in rural Kansas, such as transportation and financial barriers.

Prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the risk of inadequate prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States. PubMed/MedLine, Embase, ClinicalTrials.gov and Web of Science were searched from inception up to March 30th, 2022. Studies were included if they reported the risk of inadequate prenatal care and/or pregnancy outcomes among incarcerated pregnant individuals in the United States jails or prisons. Adequacy of prenatal care was quantified by Kessner index. The random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs) using RevMan software. Nine studies were included in thefinal review. A total of 11,534 pregnant individuals, of whom 2,544 were incarcerated while pregnant, and 8,990 who were matched non-incarcerated pregnant individuals serving as control group, were utilized. Compared to non-incarcerated pregnancies, incarcerated pregnant individuals were at higher risk of inadequate prenatal care (OR 2.99 [95% CI: 1.60, 5.61], p<0.001) and were more likely to have newborns with low birthweight (OR 1.66 [95% CI: 1.19, 2.32], p=0.003). There was no significant difference between incarcerated and matched control pregnancies in the rates of preterm birth and stillbirth. The findings of the current systematic review and meta-analysis suggest that incarcerated pregnant individuals have an increased risk of inadequate prenatal care. Considering the limited number of current studies, further research is indicated to both assess whether the risk of inadequate prenatal care has negative impact on prenatal outcomes for this population and to determine the steps that can be taken to enhance prenatal care for all pregnant individuals incarcerated in the United States prisons.

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.

Factors associated with inadequate prenatal care service utilization in Ethiopia according to the WHO recommended standard guidelines.

Adequate maternal health care could prevent 54% of maternal deaths in low- and middle-income countries. In Ethiopia, the maternal mortality rate was reduced from 817 to 412 deaths per 100,000 live births between 2000 and 2016. Thus, the current study focuses on the adequacy of prenatal care (PNC) services rather than the mere prenatal contacts available to assess compliance with the WHO recommended standard guidelines. A nationally representative cross-sectional dataset from the Ethiopian Mini Demographic and Health Survey 2019 was analyzed. Risk factors for prenatal care adequacy were assessed using a multilevel ordinal logistic regression model. About 43% of women met the old WHO recommendation of at least four prenatal contacts, while only 3.5% of women met the new WHO recommended minimum of eight prenatal contacts. The overall adequacy of prenatal care based on the four prenatal care utilization indicators was 52.1% no PNC, 37.4% received inadequate PNC and 10.5% received adequate PNC. Being a rural resident [AOR = 0.694 (95% CI: 0.557, 0.865)] and wanting no more children [AOR = 0.687 (95% CI: 0.544, 0.868)] are associated with inadequate prenatal care. Higher educational attainment of women and spouses, exposure to the media, upper wealth quintile, and a perceived shorter distance to a health facility were significantly associated with adequate prenatal care. The prevalence of adequate prenatal care was lower. Multi-sectoral efforts are needed to improve maternal health targets by reducing maternal mortality through improved health care services.