Amount Of Prenatal Care Research Articles

Social determinants of infant mortality amongst births to non-Hispanic Black women

The infant mortality rate (IMR) among Non-Hispanic Black infants in the United States is almost double the national average. This study aims to identify differences in maternal social determinants between those who experienced infant mortality compared to those who lived beyond 12 months. Population-based case-control study using publicly available US birth-death records (2014—2017). Factors potentially associated with infant mortality and considered indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women with and without infant death, ≤ 12 months. Multivariate logistic regression, reported as odds ratios (95% confidence interval, CI), quantified the association between infant mortality and social determinants such as maternal age, education level, and amount of prenatal care. Of 2,219,025 live births to Non-Hispanic Black women in the US from 2014 - 2017, 22,696 experienced infant mortality (1.0%). Factors most strongly associated with infant mortality (P< 0.001), presented as odds ratio (95% CI), were no prenatal care 3.83 (3.66 – 4.01), smoking during pregnancy 1.68 (1.61 – 1.76), father of baby information not provided on birth certificate 1.66 (1.61 – 1.70), unmarried 1.35 (1.31- 1.40), Black paternal race 1.21 (1.14 – 1.29), maternal age < 18 years 1.20 (1.11 – 1.30), and did not complete high school 1.26 (1.21 – 1.30). Factors protective for infant mortality were higher education - bachelor’s degree or greater 0.65 (0.64-0.71), WIC use 0.69 (0.67 - 0.71), and maternal age 18 – 34 years 0.94 (0.91 – 0.97). Social determinants that could increase the risk for infant mortality amongst Non-Hispanic Black infants are no prenatal care, smoking, lack of father listed on the birth certificate, unmarried, maternal age under 18, Black paternal race and no high school diploma. Addressing these indicators of social determinants of health that contribute to infant mortality can impact the disparity in IMR among Non-Hispanic Black infants.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Social Determinants of Preterm Birth Amongst Non-Hispanic Black Women

Efforts to recognize risk factors for preterm birth (PTB) are essential as this is a leading cause of perinatal mortality in the US. This study aims to identify risk factors that may be drivers of higher preterm birth rates amongst non-Hispanic black women. Population-based retrospective case-control study of the US birth records (2012—2016). Factors potentially associated with preterm birth and considered as indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women delivering preterm (< 37 weeks gestation) and term (≥ 37 weeks gestation). Multivariate logistic regression quantified the association between social determinants and PTB such as maternal age, insurance type, education level, and amount of prenatal care, and reported as odds ratios (95% confidence interval, CI). Of 2,763,235 live births to Black women in the US during the study period, 340,480 (12% of births to Black women) occurred < 37 weeks. Factors most strongly associated with preterm birth (P< .001), presented as odds ratio (95% CI) included no prenatal care 3.0 (95% CI, 2.9—3.1) or insufficient prenatal care 2.7 (95% CI, 2.7—2.8); smoking during pregnancy 1.4 (95% CI, 1.43—1.47), age ≥ 35 years 1.3 (95% CI, 1.3—1.35), unmarried 1.18 (95% CI, 1.17—1.19), lack of high school diploma 1.1 (95% CI, 1.12—1.40), lack of father of baby listed on birth certificate 1.22 (1.21—1.23), and Black paternal race 1.10 (1.08—1.12). Utilization of government-funded resources of Medicaid and WIC had opposite influence on PTB risk in Black women, OR 1.08 (1.07—1.09) and 0.83 (0.83—0.84), respectively. Non-Hispanic Black women with older age, smokers, Medicaid insurance, lower education, unmarried, lack of prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Addressing these indicators of SDH that contribute to the risk of PTB, specifically amongst Black women, may help to address the racial disparity in adverse perinatal outcomes in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Health care costs associated with changing clinics and “walk-in” deliveries: evidence supporting a regionalized health information network

The objective of the study was to describe the prevalence of changing clinics and "walk-in" deliveries and estimate associated health care costs. This was a retrospective review at an urban teaching hospital over a 6 month period. Principal outcome measures were availability of laboratory data at delivery and the number, type, and costs of duplicated tests for patients receiving various amounts of prenatal care (PNC) at our site. The prevalence of changing clinics, walk-in deliveries, and availability of records in our hospital was applied to the Los Angeles County Medicaid population to calculate the estimated cost of repeated prenatal laboratory studies. Of the 1120 patients delivered by our service, 50% received all PNC at our site, 27% transferred PNC to our site, and 23% of patients were walk-ins for delivery only. Medical records were unavailable in 26% of cases, requiring prenatal laboratory studies repeated. Costs varied by amount of PNC on site (range, $107.00-201.00). Changing clinics and walk-in deliveries are associated with significant health care costs because of redundant laboratory services and personnel costs associated with reviewing and exchanging medical records.

O0025 CONSTIPATION IN CHILDREN: INCIDENCE IN A POPULATION BASED BIRTH COHORT

Introduction: Constipation is a common complaint of childhood. However, little is known about the epidemiology of this disorder or if risk factors present at birth influence this presentation. Aims: 1. To estimate the incidence of constipation in a population based birth cohort from birth to 5 years. 2. To evaluate if biologic or socioeconomic risk factors determined at birth are associated with the presentation of constipation in children. Methods: A birth cohort of all children born between 1976 and 1982 to mothers who were residents of Rochester, MN, and who remained in the community until age 5 years (N=5718) was considered for this study. Subjects who had not denied research authorization were utilized (N=5506). Biologic (low birth weight, prematurity, multiple births, mother age <21 yo), and socioeconomic (single parent, maternal education, amount of prenatal care) risk factors were obtained from computerized state birth certificate records. Utilizing the combined medical index of the Rochester Epidemiology Project, diagnostic codes for constipation (including functional constipation, fecal retention, encopresis, but excluding Hirschsprung’s disease or identified organic gastrointestinal disorders) for the birth cohort members were identified. The medical records were reviewed to determine the date of presentation, number of medical visits, and the frequency and duration of symptoms. In addition, a group of age and gender matched controls (1:2) from the same birth cohort who did not have an identified diagnostic code were utilized for comparison of risk factors. Results: Of the 5506 birth cohort members, 158 had a medical visit for constipation before the age of 5. The sex-specific incidence for AP by age 5 years per 1000 person-years of observation was 5.4 (95% CI, 4.1–6.6) for girls, 6.3 for boys (95% CI, 5.0–7.6), and 5.8 (95% CI, 4.9–6.7) overall. The age-specific incidences were similar for girls and boys. There was no evidence to suggest that either biologic or socioeconomic risk factors influenced the presentation for constipation, although the factors are rare.Table 1: Age of Constipation DiagnosisConclusion: This is the first examination of constipation in children using a population based birth cohort.

Perinatal Substance Abuse Intervention in Obstetric Clinics Decreases Adverse Neonatal Outcomes

In 1990 the Kaiser Permanente Medical Care Program in northern California instituted a plan, based on obstetric clinics, to intervene actively in perinatal substance abuse. In addition to screening and early identification of any abuse problems, the program emphasizes early intervention, ongoing counseling, and case management by a clinical therapist located in the prenatal clinic, the Early Start Specialist, who is experienced in substance abuse. A retrospective cohort study was undertaken to assess this effort in 6774 mothers and their infants delivered from mid-1995 to mid-1998. Women found to be at increased risk of using alcohol, tobacco, or other agents during pregnancy were referred to the specialist who carried out an in-depth psychosocial assessment and formulated a follow-up management plan that included counseling when judged to be indicated. Study groups included 782 women who were screened, assessed, and treated (SAT), 348 who were screened and assessed (SA), 262 who were only screened (S), and 5382 control women without apparent substance abuse. Women in all the substance abuse groups began perinatal care after 13 weeks' gestation more often than did control women, but rates were significantly lower for the SAT than for the SA group. The total amount of prenatal care was highest for the SAT group. The SAT women were likelier than those in the SA group to have a positive toxicology screen while pregnant. Unadjusted rates of assisted ventilation, low birth weight, and preterm delivery were lowest in the SAT and control groups. The SA and S groups had significantly higher rates than control women for these outcomes, and the SAT group had lower rates than the SA and S groups. None of 24 neonatal deaths occurred in the SAT group, but there were no significant group differences in neonatal mortality rates. Multivariate logistic regression analyses adjusting for numerous factors (maternal age, ethnicity, number of prenatal visits, coming late to prenatal care) yielded similar results. Odds ratios for assisted ventilation, low birth weight, and preterm delivery were elevated in the SA and S groups compared with control women. Admission to neonatal intensive care was significantly more frequent for all the substance abuse groups. This experience points to the need to improve perinatal outcomes in nonacademic settings, and also the value of cooperative efforts by clinicians and mental health professionals. It seems wise to closely integrate substance abuse treatment with regular prenatal care.

Factors affecting maternal care in an income breeder, the European roe deer

1. Maternal care is a major component of demographic tactics in mammals. In ungulates most work has been done on capital breeders (e.g. bighorn sheep), which rely heavily on body reserves to raise their young. Roe deer, in contrast, are close to the income breeder end of the capital–income breeder continuum, and show high levels of maternal care.2. The aim of this study was to explore the factors determining the level of maternal care in roe deer, in particular the effects of maternal body weight, mother's parity, litter size and year of birth on the amount of prenatal care (i.e. the average mass of an offspring multiplied by the number of offspring) and postnatal care (i.e. the average growth rate of the offspring multiplied by their number). The study was carried out on a captive population of roe deer fedad libitum, and in a wild population.3. In both populations prenatal care increased with increasing maternal body weight. In the population fedad libitumthis effect was found in light females only (&lt; 22 kg); in the wild population the positive relationship between maternal body weight and prenatal care was entirely accounted for by variation in litter size (i.e. heaviest females produced larger litters) and density (i.e. females were lightest in years with high population density). Parity did not affect prenatal care.4. In 14 females fedad libitumthere was no relationship between postnatal care and maternal body weight. Multiparous females had higher levels of postnatal care. In contrast, 20 wild females showed a positive relationship between postnatal care and maternal body weight, and only litter size affected the level of postnatal care.5. Even after accounting for the confounding effects of maternal body weight, parity, litter size and population density, we found no trade‐off between pre‐ and postnatal care in any of the two populations. The conditions under which the pattern of maternal care could impose trade‐offs that affect the individual offspring are discussed.

Opiate and Cocaine Exposed Newborns: Growth Outcomes

ABSTRACT This investigation examined growth parameters at birth in 204 infants born to mothers who used cocaine and/or opiates during pregnancy. Analyses considered both type (cocaine, opiate or both) and pattern of in utero drug exposure. A unique feature of the investigation was the large group of opiate exposed infants. Singleton newborn infants born to cocaine and/or opiate using mothers, were recruited. Using a structured interview and urine toxicology screens, information was obtained on the type and pattern of in utero drug exposure for each infant. Outcome measures included birth weight, length, and head circumference. Birth weight and length were significantly different by type of drug exposure with the opiate only infants the largest (p = .0001) and longest (p = .008). Differences in head circumference size were not statistically significant (p = .58). Mean Zscores were 1 S.D. lower for birth weight and length and 1.5 S.D. lower for head circumference when compared to National Center for Health Statistics (NCHS) growth standards. This study provides support that in utero cocaine exposure may confer more risk for somatic growth retardation at birth than opiate exposure even when controlling for nicotine and alcohol exposure, amount of prenatal care, gender, maternal age, education and marital status.

Insufficient prenatal care in Finland and Baden-Wurttemberg. Characteristics of women and infant outcome

The amount of prenatal care and the relationship between insufficient prenatal care, mothers' characteristics and infant outcome were studied in Finland and in Baden-Wurttemberg, Germany. The main sources of data were the Finnish Medical Birth Register (N=193,659) and the Perinatal Survey of Baden-Wurttemberg (N=307,152) in 1991–1993. Insufficient prenatal care was defined as no visits, 1 or 2 visits or late attendance. Most of the women - also those in the risk groups for low use of care (foreigners, young mothers, grand multiparas, single mothers and women with a poor social status) - were using prenatal care extensively. The proportion of women having insufficient care was 3.4% in Finland and 8.1% in Baden-Wurttemberg, most of them being late attenders. Among women with insufficient care, 39% in Finland and 55% in Baden-Wurttemberg were from the risk groups identified. Foreign nationals contributed 10% of the women with insufficient care in Finland and 44% in Baden-Wurttemberg. The group of women with insufficient prenatal care was heterogeneous and it could not be defined by using traditional risk factors only. Infants of mothers with few prenatal visits had poorer outcomes, but the attributable proportion of insufficient prenatal care to infant outcome was small.

Is the lack of health insurance the major barrier to early prenatal care at an inner-city hospital?

The reasons for delayed or no prenatal care are multifactorial and range from poor access to many socioeconomic factors. Therefore, it is likely that even with health insurance available to all patients, many will not present for early prenatal care. Prenatal care is considered adequate when it begins in the first trimester of pregnancy and continues on a regular basis every 4 weeks until 28 weeks, then every 2 weeks until the 36th week, and then weekly thereafter.’ The amount of prenatal care should vary depending on the risk status of the pregnant woman.2 In the United States, approximately 5-6% of all pregnant women do not seek prenatal care until the 3rd trimester or obtain no care.3 Another study showed that in 1988, 24% of women did not receive prenatal care in the first trimester of pregnancy; specifically for black women, 40% did not receive care in the first trimester, and 11% received little or no care during pregnancy. Inadequate prenatal care is associated with poor pregnancy outcome and with a greater number of maternal and fetal complications.4 A strong association has been found between poor prenatal care and low birth weight infants, neonatal morbidity, and infant mortality. The infant mortality rate of the United States ranks 21st among industrialized countries.5 Low birth weight (~2,500 g) is a major determinant of infant mortality. This is a major health burden as each low birth weight infant can cost $400,000 over a lifetime. Every delivery of a low birth weight newborn that is prevented would save the U.S. health care system $14,000-$30,000.6 Prenatal care is also cost effective; “for every dollar spent on care for low-income, poorly educated women, $3.38 direct medical expenditures can be saved from caring for low birth weight infants during. their first vear of life.“7

Effects of social supports on attitudes, health behaviors and obtaining prenatal care

The influence of social support on attitudes, health behaviors and attaining prenatal care was assessed in 300 postpartum patients. Demographic, medical, sociocultural, attitudinal and behavioral factors were assessed by interview and review of the medical chart. Three discrete social support factors (intimacy, comfort, security) were identified by factor analysis. The presence of social support was correlated with positive prenatal attitudes, not using drugs, and adequate health resources. Stepwise multiple-regression analysis demonstrated that one social support factor (intimacy), two health behaviors (not drinking and not smoking while pregnant), and parity accounted for 22% of the variance in amount of prenatal care.

Predicting intrauterine growth retardation in sibships while considering maternal and infant covariates.

Data on 6,210 full-term sibships (gestational age greater than 36 weeks) reconstructed from birth certificates registered in Maryland between 1980 and 1984 were used to study sibship aggregation and recurrence risk of intrauterine growth retardation (IUGR) while considering maternal and infant covariates. In this study, IUGR was defined as being below the 10th percentile for race-, sex-, and gestational-age-specific birth weight based on all births registered in Maryland during 1984. Maternal factors (race, age at delivery, marital status, amount of prenatal care, concurrent illnesses, and complications during pregnancy) and infant factors (congenital malformations and first born child or not) were used as covariates in a modified logistic regression model which allowed correlation among sibs. First-time mothers who were under age 30 years, unmarried, received too little prenatal care, or had any reported pregnancy complications were at high risk of delivering an infant with IUGR. Even given the effects of these risk factors, however, there was a significant correlation in risk among full sibs (r = .237 +/- .028), which, combined with information on risk factors, can be used to estimate sibling recurrence risk for IUGR.

Effects of social supports on attitudes and behaviors of pregnant adolescents

The influence of social support on maternal attitudes and behaviors was assessed in 57 third-trimester adolescent women attending an urban prenatal clinic. Sociodemographic characteristics, social support, self-esteem, and feelings about pregnancy were measured by questionnaire. The support and influence of the adolescent father was emphasized. Social support was measured as a multidimensional construct derived by a priori and empirical procedures. The outcomes measured were the amount of prenatal care, attendance at scheduled postpartum appointments, and pleasure with the pregnancy. Stepwise multiple-regression analyses were used to assess the contributions of the predictor to criterion variables. Pleasure with pregnancy was positively associated with the receipt of assistance from the adolescent's mother, favorable opinions of friends, and satisfaction with living arrangements. Attendance at postpartum visits was associated with high self-esteem. Notably absent as significant contributors were sociodemographic characteristics, receipt of emotional and tangible support from the adolescent father, and expectation of aid from social-assistance programs.

Factors Affecting Head Growth and Intellectual Function in Children of Drug Addicts

The effect of maternal heroin and methadone use on head growth and neurodevelopmental performance was studied in preschool children of untreated heroin addicts (n = 25), women receiving methadone therapy (n = 26), and a drug-free comparison group (n = 41) who had been followed from birth. The mean birth head circumference of both groups of drug-exposed infants was significantly below that of the comparison group; however, the only factors determined by multiple regression analysis as associated with head size at birth were maternal nutritional status and birth weight. By preschool age, head size did not differ significantly among groups. The factors associated with postnatal head growth were birth weight, intrapartum risk score, and race. Data show an increased incidence of low-average and mildly retarded intellectual performance in the drug-exposed children. Regression analyses demonstrated that amount of prenatal care, prenatal risk score, and home environment were most predictive of intellectual performance and that the degree of maternal narcotic use was not a significant factor.

A comprehensive care program for pregnant addicts: obstetrical, neonatal, and child development outcomes.

This study reports the results of a comprehensive care program for pregnant addicts, one that provides medical, counseling, and child development services. Findings include the following. Women who enroll while pregnant generally stay through childbirth, and most deliveries are free of complication. Most newborns are of normal gestational age and birthweight, and these outcomes are directly related to length and amount of prenatal care. Neonatal withdrawal is directly related to prenatal maternal methadone dose. Child development, as measured by the Bayley Scales, is usually in the normal range, although mean scores for cognitive development decrease through age 2. Female babies generally have higher cognitive and motor scores than males, and their cognitive scores decline less sharply than those of the males. Developmental scores are directly related to neonatal maturity, especially birthweight. Prenatal maternal methadone dose tends to be negatively related to developmental scores for boys but not for girls.

Amphetamine addiction and pregnancy. II. Pregnancy, delivery and the neonatal period. Socio-medical aspects.

The adverse effects of amphetamine addiction during pregnancy and the neonatal period were studied in 69 Swedish women. Almost one-third of the women (Group I) succeeded in overcoming their addiction in early pregnancy. The women in Group I (n = 17), unlike those in Group II (n = 53), received the same amount of prenatal care as the average Swedish woman. An increased rate of preterm deliveries (25%) as well as a higher perinatal mortality (7.5%) was found in Group II. During the neonatal period an increased incidence of mother-infant separation was found since many of the infants (46%) were transferred to pediatric wards for medical and social reasons. All newborns in Group I and 74% of infants born to mothers with continuous amphetamine addiction throughout pregnancy remained in their mother's custody following discharge from the maternity clinic.