Content Of Prenatal Care Research Articles

Prenatal Syphilis Screening: Identification of Population Risks

Syphilis remains a leading cause of maternal and neonatal morbidity worldwide. Screening of pregnant women is an important preventative health measure, as maternal and neonatal effects are preventable if identified early. All patients receiving prenatal care at National Naval Medical Center have a rapid plasma reagin (RPR) test performed at their initial obstetric visit, in accordance with the Centers for Disease Control (CDC) guidelines and the Public Health Service Expert Panel on the Content of Prenatal Care. At the 28 week visit, this test is repeated. To better direct screening of our patient population, which is similar to other military and civilian institutions, the following study examines syphilis screening of all patients who delivered at National Naval Medical Center from February 1996 until July 1996. No patient had a positive RPR titer during this period. This study supports the CDC recommendation that RPR titers do not need to be repeated at the week 28 visit in a low-risk population. This study is pertinent to military and civilian hospitals changing to a TRI care or other HMO-based system, where observation of population risk will better direct the effectiveness of screening programs.

Does reducing the number of prenatal office visits for low-risk women result in increased use of other medical services?

To determine whether a schedule of fewer prenatal visits than traditional for women with low-risk pregnancies lead to additional medical services outside prescribed prenatal care. In a randomized, controlled trial conducted within a group-model health maintenance organization, we studied 2328 pregnant women judged to be a low risk of adverse perinatal outcomes. After risk assessment and consent, women were assigned to an experimental (nine visits) or a control (14 visits) schedule, with additional visits if requested either by providers after identifying risks or by women seeking additional services. We recorded whether women underwent maternal serum alpha-fetoprotein screening, obstetric ultrasound examinations at 15-24 weeks' gestation, hematocrit testing after 20 weeks, and diabetic screening. We also noted visits to nonobstetric care providers or our emergency care center, telephone calls, and hospitalizations. We found no significant differences between the two groups for prenatal blood tests, visits to nonobstetric providers or to the emergency care center, telephone calls from patients, or hospital admissions. A significantly greater percentage of women underwent ultrasound examinations at 15-24 weeks in the control group compared with the experimental group (57.3% and 53.1%, respectively; P = .045). The reduction in prenatal visits achieved using the experimental schedule was not accompanied by an increase in the use of other medical services compared with the routine schedule. The use of the schedule proposed by the Expert Panel on the Content of Prenatal Care improved the efficiency of delivery of prenatal care to low-risk women.

Receipt of recommended prenatal interventions and birth weight among African-American women: analysis of data from the 1988 National Maternal and Infant Health Survey.

While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators. This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data. The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed. Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.

Prenatal visits--it's not the number, it's the content.

BirthVolume 23, Issue 4 p. 236-238 Prenatal Visits—It's Not the Number, It's the Content Lnrry Culpeppec MD, MPH, Lnrry Culpeppec MD, MPH Department of Family Medicine Brown University 111 Brewster Street Pawtucket, RI 02860Search for more papers by this authorBrian Jack MD, Brian Jack MD Department of Family Medicine Brown University 111 Brewster Street Pawtucket, RI 02860Search for more papers by this author Lnrry Culpeppec MD, MPH, Lnrry Culpeppec MD, MPH Department of Family Medicine Brown University 111 Brewster Street Pawtucket, RI 02860Search for more papers by this authorBrian Jack MD, Brian Jack MD Department of Family Medicine Brown University 111 Brewster Street Pawtucket, RI 02860Search for more papers by this author First published: December 1996 https://doi.org/10.1111/j.1523-536X.1996.tb00501.xCitations: 6 Commentary on: McDuffie RS, Beck A, Bischoff K, Cross J, Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women: A randomized controlled trial. JAMA 1996;275:847–851. Sikorski J, Wilson J, Clement S, Das S, Smeeton N. A randomized controlled trial comparing two schedules of antenatal visits: The antenatal care project. BMJ 1996;312:546–553. Larry Culpepper was a member of the Expert Panel on the Content of Prenatal Care. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume23, Issue4December 1996Pages 236-238 RelatedInformation

Factors associated with inadequate prenatal care during the second pregnancies among African-American women

A longitudinally linked data set for Georgia was used to identify characteristics, including previous prenatal care use and complications at the first birth, associated with prenatal care use in the second pregnancy among 8,224 African-American women. More than 70% of the women who were <25 years of age at their first birth (younger women) and almost 40% of women who were ≥25 years at their first birth received inadequate care with at least one of their first two births. Women who received inadequate care in their first pregnancy were more likely to receive inadequate care in their second pregnancy than women who received adequate care in their first pregnancy. Younger women with a history of a stillbirth, neonatal death, or vacuum extraction were less likely to receive inadequate care in their subsequent pregnancy. Although this study was not able to evaluate the content of prenatal care, it suggested that many African-American women may not receive sufficient care to prevent adverse pregnancy outcomes. Women who receive inadequate care in their first pregnancy must be targeted for interventions that help them overcome economic, situational, or attitudinal barriers to receiving adequate care in their next pregnancy.

Prenatal care: Will the past predict the future?

In three key areas, content, availability, and effectiveness, prenatal care has enjoyed unprecedented attention and activity in the past 10 years. With regard to content of prenatal care, new guidelines were released in 1989 by the Public Health Service Expert Panel on the Content of Prenatal Care.’ The panel recommended some radical changes in the way prenatal care is delivered in the United States. The recommendations characterized prenatal care as having broad objectives to promote the health and well-being of the pregnant woman, her fetus, the infant, and the family. The report also emphasized the importance of early and continuing risk assessment, health promotion, psychosocial interventions, and preconception care as integral parts of prenatal care. In addition, the panel asserted that the specific content and timing of prenatal visits should be determined by the individual risks of the woman and her fetus. The past decade has also witnessed changes in the availability of care. Access was addressed by the federal government through Medicaid expansions that allowed women with incomes up to twice as great as the federal poverty level to have prenatal care and deliveries supported by Medicaid. Nationwide, approximately 2.6 million pregnant women and children became newly eligible for Medicaid in the years 1988 through 1991 alone.’ Finally, research on the effectiveness of prenatal care interventions has been extensive. Important trials of preterm birth prevention programs, psychosocial interventions, and smoking cessation programs were launched and completed, while the Cochrane Collaboration was undertaking extensive meta-analyses of trials of the effectiveness of each specific component of prenatal care.3 All this activity and attention created a dizzying sensation of accomplishment-for awhile. But with the passage of time, we have produced results, and some of the results are quite sobering. Providers of prenatal care have been slow to adopt the more controversial psychosocial and preconception recommendations of the Expert Panel.* Increasing the availability of prenatal care to the poor does not seem to have generated improvements in the incidence of low birth weight overall.5 And although some research results (eg, effectiveness of smoking interventionsj6 have been promising, other trials, such as preterm birth prevention programs7r8 and home visiting interventions,‘-” have generated contradictory findings. Moreover, the Cochrane Collaboration studies have shown that although a number of components of prenatal care enjoy strong evidence of effectiveness, the effectiveness of many others is not known.

Prenatal hospitalization and compliance with guidelines for prenatal care.

This study examined the relationship between compliance with the US Public Health Service guidelines for prenatal care and the rate of prenatal hospitalization. For all women admitted to a Boston referral center during January and February 1993 with a pregnancy of at least 18 weeks gestation (n = 1400), a proportional hazards model was used to examine factors associated with prenatal hospitalization. Prenatal hospitalization occurred during 248 (17.7%) pregnancies. The median length of stay for all prenatal admissions was 4 days; the medial total charge was $5667. Prior medical and obstetrical problems were strongly associated with prenatal hospitalization. After adjustment for age, race, and medical and obstetrical complications, women who received less than 70% of the prenatal care recommended were significantly more likely to be hospitalized (relative risk [RR] = 2.14, 95% confidence interval [CI] 1.50, 3.06). Prenatal hospitalization is a common, costly complication of pregnancy. Because of its association with compliance with the Public Health Service guidelines for the content of prenatal care, prenatal hospitalization may be a sentinel indicator of inadequate prenatal care amenable to intervention.

Effect of Frequency of Prenatal Care Visits on Perinatal Outcome Among Low-Risk Women

In 1989, the Expert Panel on the Content of Prenatal Care established guidelines on the timing and content of prenatal care, including a schedule consisting of fewer prenatal visits than traditionally provided, for women at low risk of adverse perinatal outcomes. We tested the hypothesis that there are no significant increases in adverse perinatal outcomes when low-risk women are seen in a prenatal care visit schedule of fewer visits than routinely advised. Randomized controlled trial. Group-model health maintenance organization. A total of 2764 pregnant women, judged to be at low risk of adverse perinatal outcomes. Following risk assessment, participants were randomly assigned to an experimental schedule (nine visits) or a control schedule (14 visits) with additional visits as indicated or as desired by the patient. Preterm delivery, preeclampsia, cesarean delivery, low birth weight and patient's satisfaction with care. On average, there were 2.7 fewer visits observed in the experimental group than in the control group. There were no significant increases in the main outcomes of the experimental group; preterm delivery (relative risk [RR], 1.08; 95% confidence interval [CI], 0.92 to 1.27; P = .19), preeclampsia (RR, 0.94; 95% CI, 0.78 to 1.14, P = .74), cesarean delivery (RR, 1.04; 95% CI, 0.93 to 1.17; P = .25), and low birth weight (RR, 0.94; 95% CI, 0.78 to 1.12; P = .76). There were no differences between the two groups in patients' satisfaction with quality of prenatal care. In this study, good perinatal outcomes and patient satisfaction were maintained when the prenatal visit schedule proposed by the Expert Panel on the Content of Prenatal Care was observed.

Content of prenatal care during the initial workup

OBJECTIVE: In its landmark document Caring for Our Future: The Content of Prenatal Care, the Public Health Service Expert Panel on the Content of Prenatal Care presented a framework for refocusing prenatal care in the 1990s. The purpose of this study was to examine the extent to which the panel's recommendations for preconceptional care and for the content of the initial prenatal workup were followed 3 years after they were issued. STUDY DESIGN: A retrospective review of the prenatal records of 147 patients in Durham and Chatham counties, North Carolina, was conducted. Providers were selected at random, and their first 10 new prenatal patients were enrolled in the study. Data were analyzed descriptively to characterize patterns in content of care and, with multiple logistic regression analysis, to determine whether there were relationships between selected maternal characteristics and receipt of selected components of care. RESULTS: Only 11% of the patients had one or more preconceptional visits. During the initial prenatal workup risk assessment through history taking and physical examination was virtually complete, whereas documentation of laboratory tests varied. Only about half the population received routine counseling on pregnancy and health behaviors. Multiple logistic regression analysis revealed a consistent association between initiating prenatal care early in pregnancy and receipt of most laboratory tests. No other consistent relationships were found. CONCLUSIONS: This study suggests that adherence to such long-standing prenatal care practices as physical examination, history taking, and some laboratory tests was high. But the components of prenatal care recommended by the expert panel to ensure behavioral risk assessments and health promotion and education early in pregnancy were provided at lower and more variable rates. Use of preconceptional care was also low. Further research into the use and content of care before and during pregnancy is required to understand variations in practice patterns and levels of adherence to recommendations on the content of care. (A M J O BSTET G YNECOL 1996;174:220-6.)

Relation of the content of prenatal care to the risk of low birth weight: Maternal reports of health behavior advice and initial prenatal care procedures

Objective. —Numerous studies have found a relationship between the quantity of prenatal care received and birth outcomes. Few studies have had the opportunity to examine the content of prenatal care. This study examined the relationship between two components of the content of prenatal care: maternal reports of health behavior advice received and initial prenatal care procedures performed during the first two visits and low birth weight in a national sample of women. Advice and initial procedures were categorized based on the recommendations of the US Public Health Service Expert Panel on the Content of Prenatal Care. Design. —Interview survey of a nationally representative sample of women who had live births in 1988. Participants. —A total of 9394 women, with data from the National Maternal and Infant Health Survey. Main Outcome Measure. —Low birth weight ( Results. —After controlling for other sociodemographic, utilization, medical, and behavioral factors, women who reported not receiving all the types of advice recommended by the Expert Panel on the Content of Prenatal Care were more likely to have a low—birth-weight infant compared with women who reported receiving the optimal level of advice (odds ratio=1.38; 95% confidence interval, 1.18 to 1.60). There were no differences between women who reported receiving all the recommended initial prenatal care procedures and those who reported not receiving all recommended prenatal care (odds ratio=1.00; 95% confidence interval, 0.87 to 1.14). Conclusion. —These data suggest that women who report receiving sufficient health behavior advice as part of their prenatal care are at lower risk of delivering a low—birth-weight infant. ( JAMA . 1994;271:1340-1345)

Relation of the Content of Prenatal Care to the Risk of Low Birth Weight

Relation of the Content of Prenatal Care to the Risk of Low Birth Weight

Relation of the Content of Prenatal Care to the Risk of Low Birth Weight

Numerous studies have found a relationship between the quantity of prenatal care received and birth outcomes. Few studies have had the opportunity to examine the content of prenatal care. This study examined the relationship between two components of the content of prenatal care: maternal reports of health behavior advice received and initial prenatal care procedures performed during the first two visits and low birth weight in a national sample of women. Advice and initial procedures were categorized based on the recommendations of the US Public Health Service Expert Panel on the Content of Prenatal Care. Interview survey of a nationally representative sample of women who had live births in 1988. A total of 9394 women, with data from the National Maternal and Infant Health Survey. Low birth weight (< 2500 g) as reported on the birth certificate. After controlling for other sociodemographic, utilization, medical, and behavioral factors, women who reported not receiving all the types of advice recommended by the Expert Panel on the Content of Prenatal Care were more likely to have a low-birth-weight infant compared with women who reported receiving the optimal level of advice (odds ratio = 1.38; 95% confidence interval, 1.18 to 1.60). There were no differences between women who reported receiving all the recommended initial prenatal care procedures and those who reported not receiving all recommended prenatal care (odds ratio = 1.00; 95% confidence interval, 0.87 to 1.14). These data suggest that women who report receiving sufficient health behavior advice as part of their prenatal care are at lower risk of delivering a low-birth-weight infant.

Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures

Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures

Promoting positive nutritional practices during pregnancy and lactation

This paper describes three key elements for promoting positive nutrition practices among women during pregnancy and lactation: 1) increasing access to prenatal care; 2) redirecting the content of prenatal care to include a greater emphasis on screening and intervention for behavioral risk factors, including poor nutritional practices; and 3) delivering nutritional care based on recent Institute of Medicine guidelines. These guidelines advise the practitioner to determine prepregnancy body mass index (BMI) and to recommend different weight gains during pregnancy according to BMI category, to assess dietary and lifestyle factors to determine the need for nutrient supplements and to base the supplement composition on the nature of the nutritional need identified, to provide routine supplementation of only 30 mg iron beginning in the second trimester of pregnancy, and to base the diagnosis of anemia on different cutoff values by stage of pregnancy and smoking status.

Differences between black and white women in the use of prenatal care technologies

OBJECTIVE: The purpose of this study was to determine whether the content of prenatal care received by black and white women in the United States differs, as measured by the use of amniocentesis, ultrasonography, and tocolysis. STUDY DESIGN: This study uses data from birth certificates issued for births occurring in the United States in 1990. Multivariate analyses were used to calculate the relative risk of receipt of each technology by black women compared with white women. RESULTS: Amniocentesis was used substantially less frequently by black women (relative risk 0.6), whereas ultrasonography was received by black women slightly less frequently than white women (relative risk 0.9). Tocolysis use varied by plurality. Black women with singleton births were slightly more likely to receive tocolysis than were white women (relative risk 1.1), although the risk of idiopathic preterm delivery is estimated to be three times higher in black women. Black women with multiple births received tocolysis two thirds as often as white women. CONCLUSIONS: These results suggest that differences exist in the content of prenatal care received by black and white women in the United States. This finding should be followed up with more detailed studies to identify its cause and possible interventions. (AM J OBSTET GYNECOL 1994;170:41-6.)

Differences between black and white women in the use of prenatal care technologies

Objective: The purpose of this study was to determine whether the content of prenatal care received by black and white women in the United States differs, as measured by the use of amniocentesis, ultrasonography, and tocolysis. Study Design: This study uses data from birth certificates issued for births occurring in the United States in 1990. Multivariate analyses were used to calculate the relative risk of receipt of each technology by black women compared with white women. Results: Amniocentesis was used substantially less frequently by black women (relative risk 0.6), whereas ultrasonography was received by black women slightly less frequently than white women (relative risk 0.9). Tocolysis use varied by plurality. Black women with singleton births were slightly more likely to receive tocolysis than were white women (relative risk 1.1), although the risk of idiopathic preterm delivery is estimated to be three times higher in black women. Black women with multiple births received tocolysis two thirds as often as white women. Conclusions: These results suggest that differences exist in the content of prenatal care received by black and white women in the United States. This finding should be followed up with more detailed studies to identify its cause and possible interventions. Objective: The purpose of this study was to determine whether the content of prenatal care received by black and white women in the United States differs, as measured by the use of amniocentesis, ultrasonography, and tocolysis. Study Design: This study uses data from birth certificates issued for births occurring in the United States in 1990. Multivariate analyses were used to calculate the relative risk of receipt of each technology by black women compared with white women. Results: Amniocentesis was used substantially less frequently by black women (relative risk 0.6), whereas ultrasonography was received by black women slightly less frequently than white women (relative risk 0.9). Tocolysis use varied by plurality. Black women with singleton births were slightly more likely to receive tocolysis than were white women (relative risk 1.1), although the risk of idiopathic preterm delivery is estimated to be three times higher in black women. Black women with multiple births received tocolysis two thirds as often as white women. Conclusions: These results suggest that differences exist in the content of prenatal care received by black and white women in the United States. This finding should be followed up with more detailed studies to identify its cause and possible interventions.

Comparing mothers' reports on the content of prenatal care received with recommended national guidelines for care.

Comparing mothers' reports on the content of prenatal care received with recommended national guidelines for care.

Preconception care: An opportunity to maximize health in pregnancy

In 1990, the United States Public Health Service published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. One of the objectives included in the family planning priority area and repeated in the maternal and infant health priority area is the following: “Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling.” Drawing on the guidelines proposed by the Public Health Service Expert Panel on the Content of Prenatal Care, this article describes the components of preconception care: 1) appropriate and ongoing risk assessment, 2) health promotion, and 3) medical and psychological interventions and follow-up. The organization of this article is based on a preconception class outline developed by the authors; recommendations included in the article are consistent with those of the Expert Panel. After discussing opportunities for providing preconception care, this article addresses: 1) helping women evaluate their psychological readiness; 2) evaluating physical readiness; 3) the examination and concerns of the father; 4) evaluating the need for genetic counseling; 5) creating a positive environment for conception; 6) discontinuing family planning methods and timing conception; and 7) choosing a provider and birth place.

Are there differences in information given to private and public prenatal patients?

In 1989 the United States Public Health Service Expert Panel on the Content of Prenatal Care reported that health education should become a more integral part of prenatal care. Key questions about providing this education have not been examined. Our study compared the type of information provided to women who sought prenatal care in a public clinic and to those who were seen in a private practice and the degree to which the patients were satisfied with the information they received. One hundred fifty-nine pregnant women (80 seen in a public clinic, 79 seen in a private practice) completed two questionnaires about 38 topics commonly cited as important during pregnancy. At the first prenatal visit, the women reported their level of interest in each of the topics. At 36 to 40 weeks' gestation the women completed a second questionnaire to assess whether information was provided for each topic and whether they had learned as much as desired. Overall, the women in the public sector received more information than did the women who were cared for privately. This was statistically significant at the p < 0.05 level for 25 of the 38 topics. Satisfaction with information learned was highly correlated with information received during prenatal care, but, surprisingly, it was not shown to be associated with the patient's interest level at the first visit. Fewer than 50% of private patients reported having received information about such important topics as acquired immunodeficiency syndrome, sexually transmitted diseases, preterm birth prevention, family planning, and family violence. The one-on-one approach to health education in pregnancy usually used in the private setting may not facilitate addressing many topics believed to be important components of contemporary prenatal care. Providers of private prenatal care should initiate discussion of prenatal health education topics rather than relying on patient interest in requesting information. Just as public prenatal care programs have devoted significant resources to more comprehensive prenatal education, the providers in the private sector must assure that pregnant women receive the same comprehensive information. In so doing, these providers can help promote an optimal outcome for their patients, their patients' unborn children, and the family unit.

Prenatal and postpartum care in Hawaii: a community-based approach.

Given the problems of access, retention, and relevant prenatal care content, supplements to existing programs for health-care delivery during pregnancy and after birth are necessary. This article describes a community-based approach to prenatal and postpartum care that has been developed to address these issues. Culturally sensitive strategies were created for use with Hawaiian, Filipino, and Japanese women living on the island of Hawaii. Six nursing care and community outreach interventions were used. Local public health nurses assisted in developing the program and are responsible for its coordination and implementation.