Inadequate Prenatal Care Utilization Research Articles

Association between language barrier and inadequate prenatal care utilization among migrant women

Abstract Background Language barriers may limit access to care and thus be associated with increased risk of adverse maternal and perinatal outcomes. Our objective is to assess the association between this language barrier and inadequate prenatal care utilization among migrant women. Methods The analysis took place in the French multicentre prospective PreCARE cohort, conducted in four university hospital maternity units in the northern Paris area, having a professional interpreting service. This cohort included 4803 migrant women registered and giving birth between 2010 and 2012. Migrants’ language barrier was categorized in three groups: no, partial or total. Inadequate prenatal care utilization was assessed according to the modified Adequacy of Prenatal Care Utilization Index through multivariable logistic regression models. Results Among the 4803 migrant women included, 16.3% had a partial and 3.8% a total language barrier. Migrants with language barrier had resided less time in France, experienced social deprivation and undocumented status more frequently than those with no language barrier. Compared to migrants with no language barrier, those with partial (RR 1.23, 95%CI 1.13-1.33) and total (RR 1.28, 95%CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity, and region of birth did not modify these association, which were noted particularly among socially deprived women. Conclusions Migrant women with language barrier have a higher risk of inadequate prenatal care utilization than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care. Key messages • Compared with migrant women with no language barrier, those with such barrier, either total or partial, have a higher risk of inadequate prenatal care utilization. • These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.

Association between language barrier and inadequate prenatal care utilization among migrant women in the PreCARE prospective cohort study.

Inadequate prenatal care utilization (PCU) is involved in the higher risk of adverse maternal outcomes among migrant vs. native women. Language barrier may be a risk factor for inadequate PCU. We aimed to assess the association between this barrier and inadequate PCU among migrant women. This analysis took place in the French multicentre prospective PreCARE cohort study, conducted in four university hospital maternity units in the northern Paris area. It included 10419 women giving birth between 2010 and 2012. Migrants' language barrier to communication in French were categorized into three groups: migrants with no, partial or total language barrier. Inadequate PCU was assessed by the date prenatal care began, the proportion of recommended prenatal visits completed and ultrasound scans performed. The associations between these language barrier categories and inadequate PCU were tested with multivariable logistic regression models. Among the 4803 migrant women included, the language barrier was partial for 785 (16.3%) and total for 181 (3.8%). Compared to migrants with no language barrier, those with partial [risk ratio (RR) 1.23, 95% confidence interval (CI) 1.13-1.33] and total (RR 1.28, 95% CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity and region of birth did not modify these associations, which were noted particularly among socially deprived women. Migrant women with language barrier have a higher risk of inadequate PCU than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.

Prenatal Care Utilization Among Pregnant Women With Substance Use Disorder: A Drug-Free Moms and Babies Project Study [ID: 1377131

INTRODUCTION: Pregnant people with substance use disorder (SUD) are more likely to have inadequate prenatal care quality/utilization. The rate of stimulants and opioids use continues to increase nationwide with significantly higher rates observed in rural and socioeconomically disadvantaged pregnant populations. The objective of this study was to quantify the association between substance use and the quality of prenatal care in the rural Appalachian pregnant population of West Virginia. METHODS: Drug-Free Moms and Babies Project is a multicenter program in West Virginia that offers coordinated care for pregnant and postpartum individuals with SUD. Secondary data analysis for this study (2018–2022) was limited to only those patients who entered the program during pregnancy (N=1,555). Kessner Index was used to categorize prenatal care quality as inadequate, intermediate, and adequate. Substance use included stimulants alone, opioids/narcotics alone, opioids/narcotics and stimulants concurrent use, and all other substances but not opioid/narcotic or stimulant use. RESULTS: Pregnant people with opioids use alone (odds ratio [OR] 2.11 [1.43–3.12]), stimulants use alone (OR, 3.27 [1.69–6.32]), and concurrent use of opioids and stimulants (OR 4.69 [2.52–8.73]) were more likely to have inadequate versus adequate prenatal care compared to those who used only other substances after adjusting for maternal income, education, medical conditions, prior children, planned/unplanned pregnancy, alcohol use, or smoking during pregnancy. CONCLUSION: Opioids/narcotics and stimulants use is associated with inadequate prenatal care utilization that becomes more pronounced with polysubstance use. Improving quality of prenatal care is critical for this population to improve the health of parent and child.

Social determinants of inadequate prenatal care utilization in homeless mothers in the Greater Paris area in France

Social determinants of inadequate prenatal care utilization in homeless mothers in the Greater Paris area in France

Social determinants of inadequate prenatal care utilization in sheltered homeless mothers in the Greater Paris area in France.

Sheltered homeless families suffer from deleterious living conditions such as housing instability (i.e., moving from one shelter to another) that could be an additional barrier to healthcare utilization. Few studies have specifically examined perinatal health in homeless mothers and their utilization of prenatal healthcare. This study aimed to identify social determinants such as living conditions (i.e., housing instability) associated with inadequate prenatal care utilization (PCU) in sheltered homeless mothers in the Greater Paris area in France. The homeless children and families cross-sectional survey [ENFAMS: (Enfants et familles sans logement)] was performed on a random representative sample of homeless families living in shelters in the greater Paris area in 2013. Following French guidelines, PCU was deemed inadequate if one or more of the following criteria was met: attending fewer than 50% of recommended prenatal visits, PCU initiation after the first trimester of pregnancy, and fewer than three ultrasounds during the entire pregnancy. Families were interviewed in 17 languages by trained peer interviewers in face-to-face interviews. Structural equation modeling was used to identify factors associated with inadequate PCU and to estimate correlations between them. This study analyzed data on 121 homeless sheltered mothers who had at least one child less than one year old. They were socially disadvantaged and most were born outside France. One in five (19.3%) had inadequate PCU. Associated factors were socio-demographic characteristics (young age, primiparous), health status (dissatisfaction with self-perceived general health), and living conditions (housing instability in the second and third trimesters). It is essential to reduce housing instability to help sheltered mothers to benefit from social, territorial and medical support and healthcare utilization. Housing stability for pregnant sheltered homeless mothers should be a priority to ensure better PCU and guarantee the newborn's health as much as possible.

Birth and prenatal care outcomes of Latina mothers in the Trump era: Analysis by nativity and country/region of origin.

We examined whether and how birth outcomes and prenatal care utilization among Latina mothers changed over time across years associated with the Trump sociopolitical environment, using restricted-use birth records from the National Center for Health Statistics (NCHS). To assess potential variation among subpopulations, we disaggregated the analyses by maternal nativity and country/region of origin. Our results indicate that both US- and foreign-born Latina mothers experienced increasingly higher risks of delivering low birthweight (LBW) and preterm birth (PTB) infants over the years associated with Trump's political career. Among foreign-born Latinas, adverse birth outcomes increased significantly among mothers from Mexico and Central America but not among mothers from Puerto Rico, Cuba, and South America. Levels of inadequate prenatal care utilization remained largely unchanged among groups who saw increases in LBW and PTB, suggesting that changes in prenatal care did not generally explain the observed worsening of birth outcomes among Latina mothers during the Trump era. Results from this study draw attention to the possibility that the Trump era may have represented a source of chronic stress among the Latinx population in the US and add to the growing body of literature linking racism and xenophobia in the sociopolitical environment to declines in health among Latinx people, especially among targeted groups from Mexico and Central America.

Host‐country language proficiency and migrant‐native disparities in prenatal care utilization: A nationwide study in Portugal

AbstractBackgroundMigrant‐native disparities in perinatal health and care utilization are well‐established, yet most evidence comes from countries without universal health coverage. Migrant‐specific factors potentially contributing to such disparities are seldom examined. We investigated the association between migration and host‐country language proficiency and inadequate utilization of prenatal care (PNC) in Portugal.MethodsWe used robust Poisson regression to analyze data from 1419 migrant and 2477 native women enrolled in the Portuguese Bambino cohort study who had given birth at a Portuguese public hospital between 2017 and 2019. Migrant women's language proficiency was self‐rated for understanding, speaking, reading, and writing skills. PNC utilization inadequacy was assessed using three dimensions: initiation, number of visits, and the modified Adequacy of Prenatal Care Utilization (mAPNCU) Index score.ResultsMigrant women were overall more likely to initiate PNC late and have inadequate/intermediate mAPNCU scores than natives. Migrant‐native disparities in the number of PNC visits were only observed among recent migrants (≤5 years in Portugal). Full, intermediate, and limited Portuguese skills were associated with increasingly higher risks of late PNC initiation (aRR 1.34 [95%CI 1.20‐1.50]); (aRR 1.52 [95%CI 1.28‐1.80]); (aRR 1.91 [95%CI 1.52‐2.40]), inadequate number of PNC visits (aRR 1.06 [95%CI 0.93‐1.22]); (aRR 1.14 [95%CI 0.97‐1.34]); (aRR 1.57 [95%CI 1.19‐2.07]), and inadequate/intermediate mAPNCU scores (aRR 1.18 [95%CI 1.07‐1.32]); (aRR 1.30 [95%CI 1.11‐1.53]); (aRR 1.69 [95%CI 1.38‐2.07]) compared with native Portuguese skills, respectively.ConclusionsMigrant‐native disparities in PNC utilization are present in Portugal, despite universal health coverage. Recent migrants and women with limited language competence are the most vulnerable to inadequate PNC use.

Prenatal care utilization in pregnant women who consider but do not have abortions

BackgroundOver half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their pregnancy. Data are limited about their utilization of prenatal care and their perinatal outcomes. Our primary outcome was to investigate differences in guideline-based prenatal care utilization in women who consider but do not have an abortion.MethodsRetrospective cohort study of patients having obstetrical dating ultrasound (US) from 2011–2018 at a single academic medical center that offers TOP. Contemplators completed US with intention of TOP but instead continued the pregnancy to live birth. A 2:1 group of non-contemplators completed US and continued to live birth. A prenatal care utilization scoring system was used to compare groups. Secondary outcomes investigated differences in adverse pregnancy outcomes and postpartum care.ResultsThere were 94 contemplators and 183 non-contemplators. Inadequate prenatal care utilization initially was more common in contemplators than non-contemplators (62.8% vs 85.8%, p < 0.01) but was not significant after adjustment (aOR 1.0, 95% CI 0.40 – 2.56). There were no differences in adverse obstetric or neonatal outcomes. Contemplators were significantly more likely to have a postpartum contraceptive method (PPCM) upon hospital discharge (aOR 4.8, 95% CI 1.16 – 20.0) and significantly more likely to use a highly-effective PPCM (aOR 6.4, 95% CI 2.34 – 17.4).ConclusionsReversal of intention for TOP is not associated with differences in prenatal care utilization, but is associated with increased uptake of postpartum contraceptive method.

Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance.

Background: Hypertensive disorders of pregnancy (HDP) cause substantial preventable maternal morbidity and mortality. Postpartum hypertension that worsens after women are discharged is particularly dangerous, as it can go undiagnosed and cause complications. The American College of Obstetricians and Gynecologists recommends women with HDP undergo blood pressure (BP) screening 7-10 days after delivery to detect postpartum hypertension. This study aimed to describe predictors of postpartum BP screening attendance among a high-risk safety-net population in Atlanta, Georgia. Materials and Methods: We conducted a population-based cohort study of pregnant women who delivered at a large public hospital in Atlanta between July 1, 2016, and June 30, 2018. We manually abstracted demographic and clinical data from electronic medical records and used multivariable log binomial regression to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) for associations with BP screening attendance. Results: Of 1260 women diagnosed with HDP, 13.7% attended a BP screening visit within 10 days of delivery. Women with preeclampsia with severe features were more likely to attend a BP visit than women with gestational hypertension (aRR 2.10, 95% CI 1.35-3.27). Rates of BP screening attendance were lower for women with inadequate (aRR 0.42, 95% CI 0.26-0.67) and intermediate (aRR 0.40, 95% CI 0.21-0.74) prenatal care utilization relative to women with adequate utilization. Conclusions: Among a high-risk safety-net population with HDP, most women did not attend a BP screening visit within 10 days of delivery. Addressing this gap requires further research and creative solutions to address barriers at the individual, provider, and system levels.

Association between Migrant Women's Legal Status and Prenatal Care Utilization in the PreCARE Cohort.

Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women’s legal status and inadequate prenatal care utilization (PCU) in France, where access to healthcare is supposed to be universal. The study population was extracted from the PreCARE prospective cohort (N = 10,419). The associations between women’s legal status and a composite outcome variable of inadequate PCU were assessed with multivariate logistic regressions. The proportion of women born in sub-Saharan Africa (SSA) was higher among the undocumented than that of other migrants. All groups of migrant women had a higher risk of inadequate PCU (31.6% for legal migrants with European nationalities, 40.3% for other legal migrants, and 52.0% for undocumented migrants) than French-born women (26.4%). The adjusted odds ratio (aOR) for inadequate PCU for undocumented migrants compared with that for French-born women was 2.58 (95% confidence interval 2.16–3.07) overall, and this association was similar for migrant women born in SSA (aOR 2.95, 2.28–3.82) and those born elsewhere (aOR 2.37, 1.89–2.97). Regardless of the maternal place of birth, undocumented migrant status is associated with a higher risk of inadequate PCU.

Risk Factors for Stunting in Children under the Age of 5 in Rural Guatemalan Highlands.

Background:Previously, a study conducted by UNICEF found that malnutrition affects approximately 80% of the indigenous children in Guatemala.Objective:Identify prevalence and risk factors for stunted growth in communities surrounding Lake Atitlán, Guatemala.Methods:Height-for-age measurements of children under the age of five, N = 84, determined stunting prevalence and presumed burden of malnutrition in this region of the Guatemalan highlands. Mothers of a subset of this sample, N = 29, were interviewed to assess factors contributing to stunting. Analysis assessed the following risk factors: inadequate nutrition, increased infectious disease risk, high rate self-report illness, inadequate breastfeeding, and inadequate utilization of prenatal care.Findings:The majority of children under the age of five were stunted (65.6%) and likely malnourished. ANOVA analysis showed significant differences in mean height-for-age Z scores (HAZs) between groups with and without adequate nutrition (F = 7.069, p = 0.013), as well has with and without high rates of self-report illness (F = 6.894, p = 0.014). Both groups with inadequate nutrition (mean HAZs = –2.9, 95% CI = [–3.58, –2.24]) and high rates of self-report illness (mean HAZs = –2.8, 95% CI = [–3.13, –2.38]) had mean HAZs that are indicative of stunting. No other risk factors were associated with stunting.Conclusion:These pilot study results offer methods by which to obtain baseline data for assessing nutritional and public health interventions to improve stunting and malnutrition status as well as the health outcomes of children in rural, indigenous communities.

Factors Associated with Antenatal Influenza Vaccination in a Medically Underserved Population.

Influenza infection in pregnant women is associated with increased risk of morbidity and mortality. Despite recommendations for all women to receive the seasonal influenza vaccine during pregnancy, vaccination rates among pregnant women in the U.S. have remained around 50%. The objective of this study was to evaluate clinical and demographic factors associated with antenatal influenza vaccination in a medically underserved population of women. We conducted a retrospective cohort study at Grady Memorial Hospital, a large safety-net hospital in Atlanta, Georgia, from July 1, 2016, to June 30, 2018. Demographic and clinical characteristics were abstracted from the electronic medical record. The Kotelchuck index was used to assess prenatal care adequacy. Relative risks and 95% confidence intervals for associations between receipt of influenza vaccine and prenatal care adequacy, demographic characteristics, and clinical characteristics were calculated using multivariable log-binominal models. Among 3723 pregnant women with deliveries, women were primarily non-Hispanic black (68.4%) and had Medicaid as their primary insurance type (87.9%). The overall vaccination rate was 49.8% (1853/3723). Inadequate prenatal care adequacy was associated with a lower antenatal influenza vaccination rate (43.5%), while intermediate and higher levels of prenatal care adequacy were associated with higher vaccination rates (66.9–68.3%). Hispanic ethnicity, non-Hispanic other race/ethnicity, interpreter use for a language other than Spanish, and preexisting diabetes mellitus were associated with higher vaccination coverage in multivariable analyses. Among medically underserved pregnant women, inadequate prenatal care utilization was associated with a lower rate of antenatal influenza vaccination. Socially disadvantaged women may face individual and structural barriers when accessing prenatal care, suggesting that evidenced-based, tailored approaches may be needed to improve prenatal care utilization and antenatal influenza vaccination rates.

761: Reversal of intention for elective termination of pregnancy is associated with inadequate prenatal care utilization

More than half of all pregnancies in the U.S. are unintended; 18% result in elective termination of pregnancy (TOP). Some women seek TOP but ultimately elect for pregnancy continuation. This subset is more likely to have delayed entry into care and less likely to attend a postpartum visit. Data is limited about their utilization of routine prenatal care. The purpose of this study was to determine if reversal of intention for TOP is associated with differences in prenatal care (PNC) utilization. Retrospective cohort study of subjects presenting for obstetrical dating ultrasound (US) from 2011-2017 at academic medical center offering TOP until 24 weeks. “Contemplators” (CON) were subjects completing US with intention of TOP who instead continued the same pregnancy to live birth. A 2:1 group of non-contemplators (NCON) were selected who completed US and continued to live birth. Primary outcome was difference in PNC utilization; adequate PNC defined as “Adequacy of Prenatal Care Utilization Index” (API) score ≥14 points. Secondary outcomes included median API score, adverse pregnancy outcomes, and postpartum contraception plan. There were 93 CON and 186 NCON. Significant demographic differences noted between groups (Table 1). Inadequate PNC utilization was more common in CON compared to NCON (47.3% vs 71.0%; OR 0.70 (0.57-0.86); p< 0.01). Significance remained after adjusting for differences in maternal characteristics (aOR 0.48 (0.28-0.90)). CON had significantly lower scores on API (median 13 (2-18) vs 15 (5-18), p< 0.01). No differences in adverse pregnancy outcomes between groups (Table 2). A post-partum contraception plan was significantly higher in CON (aOR 4.16 (1.83-9.47); p< 0.01). Reversal of intention for TOP is associated with inadequate PNC utilization. The study was underpowered to detect a difference in adverse pregnancy outcomes. Focus towards interventions to address this health care disparity in this population is imperative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association between legal status, prenatal care utilization, severe perinatal and maternal morbidity

Abstract Background Some groups of migrant women have a higher risk of inadequate prenatal care utilization (PCU), severe maternal morbidity (SMM) and severe perinatal morbidity (SPM). To better understand this association, our aim was to assess the association between the legal status and PCU, SMM and SPM during pregnancy. Methods The analysis was performed in the database of the multicenter prospective PreCARE cohort. All pregnant women registered for delivery in 4 university hospital maternity units in Paris north area from October 2010 to May 2012 were included (N = 10 419). Women whose pregnancies ended before 22 weeks of gestation or who delivered in another maternity unit were excluded (N = 820). Women were distributed according to legal status in 4 groups: non-migrants, migrants with French or European nationality, legal migrants and undocumented migrants. The associations between the legal status and the composite variables of prenatal care utilization, SMM and SPM were tested through multivariate logistic regressions also adjusted for maternal characteristics. Results The illegal status was associated with increased risk of inadequate prenatal care utilization [adjusted odds ratio (aOR) 2,52 (2,10 - 3,01)]. Overall, the prevalence of SMM was 3,2 % and SPM 7,0 %. The illegal status was associated with higher risk of SMM [aOR 1,84 (1,21 - 2,79)], especially severe hypertensive disorder of pregnancy [aOR 2,29 (1,19 - 4,40)]. However, no significant association with SPM was found [aOR 1,29 (0,95 - 1,74)]. The sensitivity analysis demonstrates that results do not change after exclusion of women who arrived less than 12 months before delivery and those who started their follow-up after 14 weeks of gestation. Conclusions The illegal status was associated with an inadequate prenatal care utilization and a higher risk of SMM, especially severe hypertensive disorder of pregnancy. Key messages The illegal status was associated with increased risk of inadequate prenatal care utilization. The illegal status was associated with higher risk of severe maternal morbidity during pregnancy.

Correlates of Trial of Labor and Vaginal Birth After Cesarean in the United States.

Background: Little is known about trial of labor after cesarean (TOLAC) uptake and vaginal birth after cesarean (VBAC) success on the national level, which is important as national-level data may help shape future clinical guidelines. This study examined correlates of trial of labor and successful VBAC among women with one prior cesarean in the United States in 2016. Materials and Methods: We used publically available birth certificate data for 2016. Outcomes were TOLAC among women with one prior cesarean (N = 338,311) and VBAC among women with a TOLAC (N = 76,688). We used logistic regression to assess the association between the outcomes and the following categories of independent variables: social determinants of health, demographic and medical factors impacting birth, behavioral factors, and geographic access. Results: About 23% of women had a TOLAC, and 74% of women with a TOLAC gave birth vaginally. Black women had higher odds of TOLAC relative to White women, but lower odds of successful VBAC. Women without a high school degree had higher odds of TOLAC and of successful VBAC compared to women who completed high school or beyond, as did women with inadequate prenatal care utilization. Conclusions: Understanding correlates of TOLAC and successful VBAC at the population level is important for developing national guidelines that can be considered and individualized at the patient/provider level.

Inadequate prenatal care utilization among women with and without methadone-treated opioid use disorders in Taiwan

AimsThe present study aims to investigate the utilization pattern of prenatal care and correlates for women with opioid use disorders (OUD) in Taiwan. MethodUsing the data linkage between the Methadone Maintenance Treatment (MMT) register with national health insurance, national birth notification system, and birth registration system, we identified 1712 pregnancies with 20 or more gestational weeks from women enrolled in the MMT (heroin-exposed: receiving no methadone treatment during pregnancy, n = 1053 by 882 women; methadone-treated: receiving methadone for at least one day during pregnancy, n = 659 by 574 women) and their 1:10 matched pregnancies from 17,060 women without substance use disorder in the period of 2004-2013. The generalized linear mixed models with negative binomial and logit distributions were performed to evaluate the relationship between individual sociodemographic, health, and addiction treatment characteristics with the number of prenatal visits and receiving prenatal care in the first trimester (i.e., early entry). FindingsEighteen percent of pregnancies by women with OUD received no prenatal services and 21% had started prenatal care in the first trimester as compared with 1% and 46% in pregnancies by women without substance use disorders. For pregnancies by women with OUD, methadone treatment was not linked associated with prenatal care visits (adjusted relative risk [aRR] = 1.02; 95% = 0.92, 1.12). For methadone-treated pregnancies, treatment enrollment before pregnancy and spousal methadone treatment elevated prenatal visits by 8% and 18% (0.48 and 1.08 visits, respectively). Additionally, HIV infection (adjusted odds ratio [aOR] = 0.30, 95% CI = 0.10, 0.83) and prior delivery (aOR = 0.05, 95% CI = 0.01, 0.19) significantly reduced the odds of early entry into prenatal care. ConclusionIntegrating addiction treatment programs with prenatal care is urgently needed to increase adequate prenatal care for pregnant women with OUD, especially the multiparous ones.

Associations Between State-Level Policies Regarding Alcohol Use Among Pregnant Women, Adverse Birth Outcomes, and Prenatal Care Utilization: Results from 1972 to 2013 Vital Statistics.

Policies regarding alcohol use during pregnancy continue to be enacted and debated in the United States. However, no study to date has examined whether these policies are related to birth outcomes-the outcomes they ultimately aim to improve. Here, we assessed whether state-level policies targeting alcohol use during pregnancy are related to birth outcomes, which has not been done comprehensively before. The study involved secondary analyses of birth certificate data from 148,048,208 U.S. singleton births between 1972 and 2013. Exposures were indicators of whether the following 8 policies were in effect during gestation: Mandatory Warning Signs (MWS), Priority Treatment for Pregnant Women, Priority Treatment for Pregnant Women/Women with Children, Reporting Requirements for Data and Treatment Purposes, Prohibitions Against Criminal Prosecution, Civil Commitment, Reporting Requirements for Child Protective Services Purposes, and Child Abuse/Child Neglect. Outcomes were low birthweight (<2,500g), premature birth (<37weeks), any prenatal care utilization (PCU), late PCU, inadequate PCU, and normal (≥7) APGAR score. Multivariable fixed-effect logistic regressions controlling for both maternal- and state-level covariates were used for statistical analyses. Of the 8 policies, 6 were significantly related to worse outcomes and 2 were not significantly related to any outcomes. The policy requiring MWS was related to the most outcomes: specifically, living in a state with MWS was related to 7% higher odds of low birthweight (p<0.001); 4% higher odds of premature birth (p<0.004); 18% lower odds of any PCU (p<0.001); 12% higher odds of late PCU (p<0.002); and 10% lower odds of a normal APGAR score (p<0.001) compared to living in a state without MWS. Most policies targeting alcohol use during pregnancy do not have their intended effects and are related to worse birth outcomes and less PCU.

Affluent-Born White Mother's Descending Neighborhood Income and Infant Mortality: A Population-Based Study.

Objectives To determine whether affluent-born White mother's descending neighborhood income is associated with infant mortality rates (< 365day, IMR). Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of singleton births (1989-1991) to non-Latina White mothers (1956-1976) with an early-life residence in affluent neighborhoods (defined as the fourth quartile of income distribution). The breadth of descending neighborhood income was defined by mother's neighborhood income at the time of delivery. Results Infants of White mothers (n = 4890) who did not suffer descending neighborhood income by the time of delivery had a first-year mortality rate of 5.1/1,000. Infants of White mothers who experienced minor (n = 5112), modest (n = 2158), or extreme (n = 339) descending neighborhood income had IMR of 6.5/1,000, 14.4/1,000, and 11.8/1,000, respectively; RR [95% CI] = 1.3 [0.8, 2.1], 2.8 [1.7, 4.8], and 2.3 [0.8, 6.6], respectively. The incidence of young maternal age, inadequate prenatal care utilization, and cigarette smoking rose as descending neighborhood income increased, p < 0.01. In multilevel logistic regression models, the adjusted (controlling for selected individual-level co-variates) OR [95% CI] of infant mortality for White women with an early-life residence in affluent neighborhoods who subsequently experienced minor or modest to extreme (versus absent) descending neighborhood income equaled 1.0 [0.6, 1.8] and 2.1 [1.1, 3.8] respectively. Conclusions White mother's modest to extreme descending neighborhood income from early-life residence in affluent neighborhoods is associated with a twofold greater risk of infant mortality independent of selected biologic, medical, and behavioral characteristics.

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

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

198: Inadequate prenatal care increases the risk for stillbirth

To determine whether inadequate prenatal care (PNC) utilization is associated with stillbirth (SB). The Stillbirth Collaborative Research Network (SCRN) was a population-based case control study that enrolled all SB (cases) and a representative sample of live births (LB; controls) in 5 geographic areas. The Adequacy of Prenatal Care Utilization Index (APCNU) was used to divide PNC into 4 classes based on gestational age (GA) at initiation to PNC and percentage of recommended visits (RV) received. Number of RV depends on both GA of the newborn and GA at entry to PNC, based on American College of Obstetrics and Gynecology guidelines. Quality of PNC was defined as: Inadequate (care begun after month 4 or <50% of RV), Intermediate (care begun by month 4 and 50-79% of RV), Adequate (care begun by month 4 and 80-109% of RV), and AdequatePlus (care begun by month 4 and ≥110% of RV). Analysis used Univariate chi-squared tests, student t-tests, and multivariable logistic regression. Of 2393 participants with data in SCRN, 594 SB and 1799 LB were identified. Of these, 21.8% (522) had Inadequate PNC, 6.1%(146) had Intermediate PNC, 27% (646) had Adequate PNC, and 45% (1079) had AdequatePlus PNC. The median number of PNC visits was 6 (4/9 for 25-75%) for SB and 10 (7/12, 25-75%) for LB (p<0.001). The mean (± SD) GA at initiation to PNC was 11.3±5.76 weeks for SB and 12±6.57 weeks for LB (p=0.01). Inadequate PNC was associated with SB in univariate analysis (p<0.001). Placental abruption, pre-delivery antibiotics, induction of labor, fetal sex, history of pregnancy loss or SB, pre-gestational diabetes mellitus, chronic hypertension, maternal BMI, cigarette use within 3 months of pregnancy, marital status, and fetal anomaly were also associated with SB in univariate analysis (p<0.05). Inadequate PNC remained associated with SB in multivariable analysis after adjusting for risk factors (OR=1.66, 95%CI: 1.05-2.66. p<0.001, see Table 1 for covariates, R2=0.19). In this model, Intermediate PNC (OR=2.59, 95%CI: 1.04-2.66) or AdequatePlus PNC (OR=4.01, 95%CI: 2.72-5.92) also increased the risk of SB compared to women with Adequate PNC. Inadequate and Intermediate PNC is associated with an increased risk for SB. Although having AdequatePlus PNC was associated with an increased risk for SB, this may be due to high-risk conditions requiring more visits. PNC quality may be a modifiable risk factor for SB.