Effect Of Prenatal Care Research Articles

The Effect of Prenatal Care on Preterm Birth in a Low-Income Minority Population in DC [ID: 1378551

INTRODUCTION: Structural and social barriers to health care affect prenatal care (PNC) utilization among underrepresented minorities in the District of Columbia (DC) and contribute to preterm birth (PTB) disparities. The PTB rate among Black people in DC was 13.1% (2018–2020), higher than the overall DC (9.8%, 2020) and United States (10.1%, 2020) rates. We evaluated the association between prenatal care utilization and preterm birth in a low-income minority population in DC. METHODS: As part of a collaborative effort with DC Health to reduce PTB, we designed a REDCap database to collect pregnancy and delivery data on all inpatient and outpatient patients at Howard University Hospital (HUH), between January 2020 and September 2022. Our primary exposure variable was PNC (yes or no). Our outcome was PTB (gestational age < or ≥37 weeks). Crude and adjusted logistic regression models analyzed the relationship between prenatal care and preterm birth. RESULTS: A total of 1,382 patient charts were evaluated, of which 11.6% had PTB and 95.1% had any PNC. Majority were Black (55.6%) or Hispanic (42.8%), and had Medicaid (92.2%). Any PNC was associated with a 54% reduced odds of PTB (adjusted odds ratio 0.46, 95% CI 0.22–0.97). Additionally, history of preeclampsia (3.75, 2.51–5.62) or spontaneous PTB (2.51, 1.50–4.18) were significantly associated with PTB. CONCLUSION: Prenatal care usage was associated with reduced odds of preterm birth in our population. Identifying and addressing barriers to prenatal care utilization may improve preterm birth rates among risk-entrenched patients at HUH.

Identification, Semiparametric Efficiency, and Quadruply Robust Estimation in Mediation Analysis with Treatment-Induced Confounding

Natural mediation effects are often of interest when the goal is to understand a causal mechanism. However, most existing methods and their identification assumptions preclude treatment-induced confounders often present in practice. To address this fundamental limitation, we provide a set of assumptions that identify the natural direct effect in the presence of treatment-induced confounders. Even when some of those assumptions are violated, the estimand still has an interventional direct effect interpretation. We derive the semiparametric efficiency bound for the estimand, which unlike usual expressions, contains conditional densities that are variational dependent. We consider a reparameterization and propose a quadruply robust estimator that remains consistent under four types of possible misspecification and is also locally semiparametric efficient. We use simulation studies to demonstrate the proposed method and study an application to the 2017 Natality data to investigate the effect of prenatal care on preterm birth mediated by preeclampsia with smoking status during pregnancy being a potential treatment-induced confounder.

The effect of prenatal care in obese women on infant Apgar score at 5 minutes

The effect of prenatal care in obese women on infant Apgar score at 5 minutes

Effect of Prenatal Care Frequency, Timing, and Quality on Child Birth Weight in Tajikistan

We focus on identifying the effects of prenatal care on child birth weight in Tajikistan. We evaluate the effects of frequency, timing, and the quality of received care by estimating instrumental variable models. The results of two-stage least square (2SLS) indicate that an additional prenatal visit improves birth weight by 89 g, which constitutes approximately 2.7 percent of the original raw mean. Similarly, a one-unit increase in the quality of prenatal care improves birth weight by 130 g, which represents about 9.2 percent of the original mean. Likewise, having the first prenatal visit take place during the first trimester improves birth weight by 304 g, which is about 3.9 percent of the original mean. Although prenatal care in Tajikistan suffers from various inefficiencies, it nevertheless remains an instrumental factor in improving birth outcomes in the country. Finally, issues of endogeneity that result from self-selection and the importance of adjusting for child selection for being weighed are highlighted.

The effects of prenatal care on cesarean section rates in a maternity and children’s hospital

Amac. Calisma, kadinlarin dogum oncesi bakim hizmeti alma durumlarinin tespit edilmesi ve dogum oncesi bakim hizmeti almanin sezaryen dogum sikligi uzerine etkisini belirlemek amaciyla planlanmistir. Yontem. Tanimlayici tipteki arastirma, Saglik Bakanligi’na bagli Manisa Dogum ve Cocuk Bakimevi Hastanesi Obstetri kliniginde yatan yeni dogum yapmis annelerle yapilmistir (n=269). Veriler, arastirmacilar tarafindan literatur taranarak olusturulan soru formu ile toplanmistir. Soru formu iki bolumden olusmaktadir; ilk bolum kadinlarin sosyodemografik ve obstetrik ozellikler ve ikinci bolum kadinlarin aldiklari dogum oncesi bakim hizmetleri ile ilgilidir. Calismada tanimlayici bulgular ve dogum oncesi bakim hizmetlerinde verilen egitimler sayi ve yuzde gibi tanimlayici istatistikler ile ve sosyodemografik ozellikler ile dogum sekilleri ki-kare analizi ile degerlendirildi. Bulgular. Calismada kadinlarin %97’sinin dogum oncesi bakim hizmetini en az 1 kez aldigi belirlendi. Kadinlarin 8’inin (%3) dogum oncesi bakim almamis ve DOB almayanlardan sadece 1’inin (12,5%) sezaryenle dogum yapmistir. Calismada gebeliginde dort ve daha fazla dogum oncesi bakim hizmeti alanlarda, bu hizmeti sadece doktordan alanlarda, hizmeti sadece ozel kurumlardan alanlarda ve gebeliginde ultrasonografi cekilenlerde sezaryen oranlari daha yuksek oldugu belirlenmistir. Ayrica calismada, dogum oncesi bakim hizmetlerinin icerigini olusturan egitimlerin yetersiz kaldigi, kadinlarin dogum ve dogum sekilleri konusunda yeterli bilgi ve danismanlik hizmeti verilmedigi bulunmustur. Sonuc. Calisma sonuclarina gore nitelikli dogum oncesi bakim hizmetlerinin tibbi gerekcesi olmayan sezaryen dogumlarin onlenmesine onemli katkida bulunabilecegi dusunulmektedir

Effects of prenatal care on maternal postpartum behaviors.

Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is "too little too late" to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child's life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions.

Within prisons, is there an association between the quantity of prenatal care and infant birthweight?

There is still controversy surrounding the effectiveness of prenatal care in reducing low birthweight. In addition, very few studies have assessed the relationship between prenatal care and infant birthweight among pregnant women within the prison system. We sought to ascertain whether there is an association between the quantity of prenatal care and infant birthweight among pregnant women within such a setting. We examined the prison medical records of 147 infants born to women delivering at term (37-41 weeks of gestation) between 1 January 2002 and 31 December 2004 who were incarcerated during pregnancy in Texas state prisons. Linear regression was used to evaluate the association between the number of prison prenatal care visits and infant birthweight while adjusting for potential confounders (age, gravidity, maternal education, maternal race, history of substance use, history of alcohol use, history of tobacco use and the presence of any chronic disease). We also adjusted for the interaction between the gestational age at admission to prison and the number of prison prenatal care visits. There was a statistically significant 120.5 g increase in adjusted mean birthweight with each additional prison prenatal care visit (P = 0.001) among study infants whose mothers entered prison during the first trimester. This trend was not observed among women who came in after the first trimester. There appears to be a positive association between the amount of prison prenatal care and infant birthweight among incarcerated pregnant women delivering at term, but this association appears to be limited to women entering prison during the first trimester of pregnancy.

Prenatal care and birthweight production: evidence from South America

Research using US data has shown that increases in prenatal care have positive effects on birthweight and that the existence of unobserved health heterogeneity tends to reduce the measured effect of prenatal care. This study extends extant research to the South American countries of Bolivia, Brazil, Columbia and Peru using data from the demographic and health surveys, finding a positive effect of increased prenatal care use on birthweight. Furthermore, the largest marginal effect of increased prenatal care use is found at low levels of usage. The results highlight both the usefulness of existing methodologies for estimating the effect of prenatal care on birthweight and the importance of extending these methodologies to data from countries other than the USA.

Maternal health: does prenatal care make a difference?

This research attempts to close an important gap in health economics regarding the efficacy of prenatal care and policies designed to improve access to that care, such as Medicaid. We argue that a key beneficiary-- the mother-- has been left completely out of the analysis. If prenatal care significantly improves the health of the mother, then concluding that prenatal care is 'ineffective' or that the Medicaid expansions are a 'failure' is premature. This paper seeks to rectify the oversight by estimating the impact of prenatal care on maternal health and the associated cost savings. We first set up a joint maternal-infant health production framework that informs our empirical analysis. Using data from the National Maternal and Infant Health Survey, we estimate the effects of prenatal care on several different measures of maternal health such as body weight status and excessive hospitalizations. Our results suggest that receiving timely and adequate prenatal care may increase the probability of maintaining a healthy weight after the birth and, perhaps for blacks, of avoiding a lengthy hospitalization after the delivery. Given the costs to society of obesity and hospitalization, these are benefits worth exploring before making conclusions about the effectiveness of prenatal care-- and Medicaid.

Adequacy of prenatal care and birthweight: a systematic review

This was a systematic literature review on publications in which prenatal care was investigated as a predictive factor for birthweight. The MEDLINE, Cochrane Library, and SciELO databases were searched using a combination of the following uniterms: "prenatal care", "antenatal care", "quality", "adequacy", "birthweight", and "low birthweight". Twenty-five studies were found: seventeen had a cross-sectional design, in addition to four cohort studies, three case-control studies, and one randomized trial. The adequacy indicators related to utilization (quantitative measures) and content of prenatal care (process or qualitative indicators). Most authors employed quantitative indicators, mainly the Kessner Index and the Adequacy of Prenatal Care Utilization Index. Qualitative criteria were used in only two studies. Most of the cross-sectional studies found a protective effect of prenatal care against low birthweight, whereas results of studies with other designs were conflicting. This review's findings highlight that the impact of prenatal care on birthweight is not unequivocal, mainly due to the effect of self-selection bias. Randomized trials are needed to elucidate such a relationship.

Assessing the effect of prenatal care on birth outcome in Taiwan

The purpose of this paper is to assess the effect of prenatal care on birth outcome, based on the case of Taiwan. The determinants affecting a woman’s pregnancy resolution, infant birth outcome, and demand for prenatal care are also estimated. The study makes use of a national survey on the knowledge of, attitude toward, and practice of family planning and reproductive health among married women in Taiwan that was conducted in 1998. The results show that prenatal care has a significant and positive effect on birth outcome. In addition, number of previous children born and not smoking were found to be positively correlated with a better birth outcome. The estimation results also showed that those women with a lower number of previous induced abortions, living in areas with more number of hospitals per thousand persons and with a higher local female unemployment rate were more likely to give birth. Meanwhile, greater fertility, living in a non-metropolitan area, and a higher local female unemployment rate were found to be negatively associated with the use of prenatal care.

Selection bias in prenatal care use by Medicaid recipients.

This study examines whether four types of selection bias in estimates of the effectiveness of prenatal care utilization for improving birthweight occur in a population of economically disadvantaged women. We categorized adequacy of prenatal care use using the Adequacy of Prenatal Care Utilization Index (APNCU) and the Revised-GINDEX for 142,381 Medicaid recipients who gave birth to a live, singleton infant in Washington State (1994-1998). Multinomial logistic regression was used to model categories of adequacy of prenatal care use as functions of variables chosen to indicate high- or low-risk status. A series of linear regression models were estimated to quantify the magnitude and direction of any bias in the effects of prenatal care on birthweight that could be attributed to accounting for each risk covariate. Results were examined for patterns of risk, prenatal care use, and estimation bias equated with the four selection processes. We found modest evidence of adverse, favorable, confidence, and estrangement selection biases. The overriding effect, relative to low prenatal care use, was overestimation of the adequate care coefficient by 8.68 g with the APNCU, and underestimation by 3.36 g with the R-GINDEX because of competing confidence and estrangement selection biases. Relative to intensive use, the effect of adequate care on birthweight was underestimated (17.58 g with the APNCU; 13.34 g with the R-GINDEX) because of adverse selection bias and a small countervailing favorable selection process. The underestimation of birthweight associated with prenatal care noted in prior studies appears to result from multiple selection processes working in different directions. Understanding selection processes can help the assessment of the contribution of prenatal care to birth outcomes and development of appropriate programs and policies.

Neonatal Death Risk: Effect of Prenatal Care Is Most Evident after Term Birth

Neonatal Death Risk: Effect of Prenatal Care Is Most Evident after Term Birth

Recent Evidence on the Effectiveness of Prenatal Care

To assess the evidence of effectiveness of prenatal care. A 2-day conference with commissioned papers with summary at the Agency for Healthcare Research and Quality. Effectiveness of prenatal care in preventing prematurity, intrauterine growth restriction, and birth defects and in improving women's health. Current technology provides limited ability to prevent adverse fetal outcomes but may do much to ameliorate morbidity. However, the latter is not well assessed in data systems. In contrast, the opportunity to improve women's health appears much greater, but doing so is hampered by a number of structural and attitudinal barriers.

Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.

Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of the research controversies and challenges facing investigators and advocates who seek to establish the value of prenatal care. In addition, the authors recommend directions for future research to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.

Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research

Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research

Adequacy of prenatal care and pregnancy outcome.

The objective of this study was to determine whether a relationship exists between adequacy of prenatal care and preterm delivery, low-birth-weight, and small-for-gestational-age infants. Data from 1771 patients enrolled in an ongoing study of maternal growth in young gravidas were studied. The indices of both Kessner and colleagues (the Kessner index) and Kotelchuck (the Kotelchuck index) were used to determine adequacy of prenatal care. Patients receiving adequate care were compared with those receiving intermediate or inadequate care and the incidence of preterm birth, low-birth-weight, and small-for-gestational-age infants was determined in each group. The study controlled for potential confounding variables, that is, black ethnicity, maternal age, pregravid body mass index, parity, adequate prenatal weight gain, smoking, and previous delivery of low-birth-weight or preterm infant. The data were analyzed by logistic regression. When classified according to the Kessner index, 290 (16.4%) of the women received inadequate care, 961 (54.3%) received intermediate care, and 520 (29.4%) received adequate care. By the Kotelchuck index, 651 (36.8%) of the women received inadequate care, 201 (11.3%) received intermediate care, 604 (34.1%) received adequate care, and 315 (17.8%) received adequate-plus care. By use of the Kessner index and by estimating gestation from the last menstrual period, it was determined that women who received inadequate care had a 2.8 times greater risk (95% confidence interval [CI], 2.07-3.78), and by use of the Kotelchuck index, a 2.1 times greater risk (95% CI, 1.58-2.81) of having a preterm delivery. When the obstetric estimate of gestation was used, risk was 2.01 times greater (95% CI, 1.44-2.80) with the Kessner index and 1.4 times greater (95% CI, 1.0-1.94) with the Kotelchuck index. There was little effect of prenatal care on incidence of small-for-gestational-age infants. The results of this study confirmed that inadequate prenatal care is associated with an increased risk of preterm delivery.

Elimination of public funding of prenatal care for undocumented immigrants in California: A cost/benefit analysis

Objective: We compared the perinatal outcomes and costs of undocumented women with and without prenatal care and inferred the impact of denial of prenatal benefits to undocumented immigrants in California. Study Design: We retrospectively reviewed the delivery records of a cohort of 970 undocumented immigrants. The effects of prenatal care on low birth weight and prematurity were evaluated by means of logistic regression. The difference in the costs of postnatal care between neonates with and without prenatal care was compared with the cost of prenatal care. This ratio was extrapolated to calculate the net cost to the state. Long-term morbidity costs were also considered. Results: Nearly 10% of undocumented women had no prenatal care. These women were nearly 4 times as likely to be delivered of low birth weight infants (relative risk, 3.8; 95% confidence interval, 2.03-7.05) and >7 times as likely to be delivered of premature infants (relative risk, 7.4; 95% confidence interval, 4.35-12.59) as were undocumented women who had prenatal care. The cost of postnatal care for a neonate without prenatal care was $2341 more initially and $3247 more when incremental long-term morbidity cost was added than that for a neonate with prenatal care. For every dollar cut from prenatal care we expect an increase of $3.33 in the cost of postnatal care and $4.63 in incremental long-term cost. Elimination of publicly funded prenatal care for undocumented women could save the state $58 million in direct prenatal care costs but could cost taxpayers as much as $194 million more in postnatal care, resulting in a net cost of $136 million initially and $211 million in long-term costs. Conclusions: Elimination of public funding of prenatal care for undocumented immigrants in California could substantially increase low birth weight, prematurity, and postnatal costs. (Am J Obstet Gynecol 2000;182:233-9.)

Does inadequate prenatal care contribute to growth retardation among second-born African-American babies?

The authors evaluated the relation between adequacy of prenatal care and risk of delivery of full term small-for-gestational-age (SGA) infants. Data were derived from maternally linked birth certificates for 6,325 African-American women whose first two pregnancies ended in singleton, full term live births in Georgia from 1989 through 1992. The authors used stratified analysis to assess the effect of prenatal care on the risk of having an SGA baby in the second pregnancy among women with and without an SGA baby in their first pregnancy. The group of women with a history of SGA birth may be more likely to include persons for whom SGA delivery is related to factors, such as genetics, that are not amenable to intervention by prenatal care. Inadequate prenatal care was not associated with the risk of SGA delivery among women who had previously delivered an SGA baby. In unadjusted analyses, inadequate prenatal care was associated with an increased risk of delivering a full term SGA baby in the second pregnancy among women whose first baby was not SGA (risk ratio = 1.28; 95% confidence interval: 1.05, 1.55). The association did not persist when data were adjusted for confounding variables (odds ratio = 1.11; 95% confidence interval: 0.89, 1.38). Regardless of outcome in the first pregnancy, adequate prenatal care did not reduce the risk of full term SGA birth among second pregnancies in this population.

PMD8 Prenatal Care And Birth Weight in the United States

This study is the first to examine the determination of birth outcomes, employing individual data at the national level in the U.S. The data source is from the 1987 U.S. linked birth/infant death certificates. Our analytical framework is to estimate the infant health production function from a behavioral model in which health inputs are themselves choices. We place major emphasis on the instrumental variables method of estimation to correct for the endogeneity bias. The effects of endogenous inputs, such as prenatal care, maternal age, and fertility, on birth weight are investigated. We specially focus on the analysis of the effect of prenatal care on birth weight, controlling for endogeneity of prenatal care, maternal age, and fertility. We find that OLS underestimates the gains to prenatal care by a factor of 9.4 for blacks, about 3.1 for whites, and 4.8 for the pooled blacks and whites sample. Black mothers who seek prenatal care one month earlier give birth to babies 124 g more in birth weight, while for white mothers the corresponding number is about 99 g. The policy implications for this study are straightforward. The benefits for public prenatal care programs appear substantial, especially for blacks. Moreover, costeffective approaches to improving birth outcomes through the expanded utilization of prenatal care will motivate women who otherwise would receive late or no care to begin care in the early trimester.