Prenatal Medical Care Research Articles

Prenatal care experiences and birth weight among Mexican immigrant women.

National studies indicate that Mexican immigrant women tend to have more positive birth outcomes than other groups, despite receiving relatively low levels of medical prenatal care. Our study-based on in-depth interviews with immigrant women who had recently given birth in Chicago-examines women's experiences seeking prenatal care. Qualitative findings contribute to understanding why many of these women received less than optimal care during pregnancy. The study also offers modest evidence that, despite overall positive birth outcomes and low levels of prenatal care, adequate prenatal care may make a difference in birth outcomes in this group. Suggestions are made concerning ways to improve access to adequate care, paying particular attention to the impact of migration and communication in prenatal care.

The role of social workers in providing comprehensive health care to pregnant women.

Prenatal care is an important women's health care issue. Numerous studies have shown that early monitoring and continuous care during pregnancy is associated with more favorable birth outcomes. Using data from a survey of service providers, this paper describes innovative service delivery models that are a part of Washington state's new, comprehensive maternity care system. Washington's program departs from traditional medical prenatal care in making both support and case management services available to pregnant women. The services are described, highlighting the roles that social workers play in providing maternity services.

The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada.

Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. Measures of prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12,646 pregnant women. Maternal socioeconomic status was derived from small-area census data. Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The difference in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was no greater among women with pregnancy complications. The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care.

Health inputs and child mortality: Malaysia

This paper is concerned with the relationship between child mortality and the use of health care. We develop a simultaneous model of fetal and postnatal mortality risks and input demand equations for prenatal medical care and institutional delivery. This model is applied to retrospective data from Peninsular Malaysia covering 1950–1988. The results show that prenatal medical care and institutional delivery have strong beneficial effects on child survival probabilities, and that these effects are substantially underestimated when adverse self-selection among users of health care is ignored. The effectiveness of prenatal health care in Malaysia improved until 1980, and then deteriorated. We find that the risk of infant and child mortality is not independent of fetal survival, but show that ignoring selective fetal survival introduces only mild biases in infant and child mortality estimation. Higher infant and child mortality rates among young mothers are partly explained by their lower likelihood of purchasing health care.

Teenage Pregnancy and Child Health in the Urban Sahel

Longitudinal data for more than 20,000 live births in the cities of Bamako (Mali) and Bobo-Dioulasso (Burkina Faso) are used to study the effects of young maternal age (less than 18 years and 18-19) on birth weight, child health care and feeding behavior, and child mortality, after controlling for other socioeconomic and demographic factors. Teenage pregnancies are associated with significantly worse prenatal health care and vaccination behavior, lower birth weights, earlier weaning, and, especially during the second year of life, higher mortality. A proxy for mother's school enrollment at the time of pregnancy is strongly linked to worse prenatal health behavior and weakly associated with other poor behaviors and health outcomes. Overall, the results highlight the importance of behavioral factors relative to strictly biological factors for explaining child health differentials.

Effectiveness of Health Care Services for Pregnant Women and Infants

The authors of this paper focus on the health care services received by pregnant women and infants, and consider the ways in which these services affect child health outcomes. They examine the impact of prenatal, obstetrical, and neonatal care on two measures of infant health: the rate of low birth weight births and the rate of infant mortality. There is strong evidence that these two outcomes respond favorably to the application of appropriate health services, particularly prenatal care and neonatal intensive care. The delivery of prenatal care in the United States needs improvement: slightly more than 76% of women received early care in 1989, and discrepancies in prompt receipt of care among different ethnic and economic groups are large and persistent. Improved distribution of prenatal care services could have a significant impact on the rate of low birth weight births and infant deaths. In addition, expanded regionalization of prenatal, obstetric, and neonatal care in a coordinated approach to the entire continuum of gestation, labor, delivery, and early development holds out the promise of continued improvement in infant health. Health care initiatives need to focus more on the needs of poor families and of mothers and infants with special problems, especially high-risk pregnancies resulting from maternal substance abuse and pregnancies complicated by HIV infection. The authors describe advances in obstetrical technology and neonatology, and conclude that efforts to identify programs and activities which offer the greatest potential for improving newborn survival with the least investment should have high priority. C hildren are developing organisms. They continually grow and differentiate from one physical and psychological state to the next. An understanding of childhood health status, therefore, begins with an understanding of the conditions out of which children emerge. Intrauterine and neonatal environments are crucial determinants of a child’s well-being. A mother’s health throughout pregnancy, the process of labor and delivery, and a child’s experiences during the first critical hours and days of life will influence health status for months and years afterward. Moreover, poor birth outcomes have been associated with impeded cognitive development, reductions in years of formal schooling completed, and lower levels of lifetime earnings and other measures of economic well-being. Recognition of these principles has led policy analysts to give increasing attention to prenatal and neonatal health care services. In this paper we focus on health care services received by pregnant women and infants, and consider the ways in which these services affect child health outcomes. For our purposes, these services include prenatal medical care received by women during the course of their pregnancies, obstetrical care received at the time of delivery, and medical care received by newborn infants during the first 28 days of life (the neonatal period). We consider trends in these services over time, differentials in the receipt of these services among various groups in the population, and the impact utilization of these services has on child health outcomes. Two population outcome measures to which we devote particular attention are rates of low birth weight (LBW) and infant mortality. A low birth weight baby is one born weighing less than 2,500 grams (about 51⁄2 pounds). The LBW rate is the number of such births per 1,000 live births in the population in a given year. The infant mortality rate is measured by the annual number of deaths among children in the first year of life per 1,000 live births. Because LBW babies have a higher risk of death than normal weight babies, these two rates are closely related. Though birth weight and infant mortality each have a genetic component, birth weight depends very much upon the length and quality of the fetal experience during pregnancy while infant mortality depends also upon the type of care, medical and otherwise, that a child receives after birth. Therefore, these two measures may tell us much about the effectiveness of prenatal and neonatal care. We begin with a discussion of prenatal care and its relationship to low birth weight and then proceed to a consideration of obstetrical and neonatal care and how they affect infant mortality. We shall also mention some promising new technologies being applied in the field of

The Maternal-Fetal Dyad Exploring the Two-Patient Obstetric Model

Developments in obstetric medicine during the past ten to twenty years have transformed the clinical status of the fetus. [2] Traditionally physicians have been trained to assess fetal condition by indirect methods: palpating the fetus through the maternal abdominal wall and uterus, measuring hormonal milieu through maternal urine and serum, estimating statistical risks from parental medical histories. While the skillful use of these methods could produce highly reliable clues to fetal health and development, the fetus itself eluded direct examination. Throughout pregnancy the fetus could not be known, but only approached inferentially and probabilistically. Until recently suspected fetal anomalies have been treated indirectly too, by therapeutically managing the maternal environment. Unable to interact with the fetus in clear distinction for its host, physicians conceptualized the maternal-fetal dyad as one complex patient, the gravid female, of which the fetus was an intergral part. High-resolution ultrasonography and techniques for sampling fetal blood, urine, and other tissue have changed this conceptual scheme. These diagnostic tools penetrate the opaque environment and reveal the fetus to clinical observation in all its anatomical, physiological, and biochemical particularity. When anomalies are detected, in utero medical and surgical procedures are already beginning to offer alternatives to therapeutic delivery and neonatal treatment. The biological maternal-fetal relationship has not changed, of course, but the medical model of that relationship has shifted emphasis from unity to duality. Clinicians no longer look to the maternal host for diagnostic data and a therapeutic medium; they look through her to the fetal organism and regard it as a distinct patient in its own right. What ethical implications flow from the fetus's transformation from inferred to observed entity? Unfortunately, legal developments have tended to preempt ethical exploration of the new two-patient obstetric model. Some physicians, assuming enhanced rights on the part of the fetal patient, have sought and obtained court orders to perform fetal therapies (notably cearean deliveries) without maternal consent. [3] Although few in number, these cases raise the possibility of a new standard of clinical practice with far-reaching implications for civil and criminal liabilities to physicians and pregnant women. With legal stakes so high, it is not surprising that ethical inquiry has been displaced. Yet in the absence of independent and thorough ethical analysis one cannot judge whether these developments are compatible with fundamental values of medicine and medical care, and so one cannot know whether physicians have responsibilities, individually or collectively, to promote or resist them. Well-grounded in law and ethics or not, cases of court-ordered fetal therapy have set the agenda for debate, focusing attention on the question, What should the physician do when a pregnant woman refuses medical or surgical treatment recommended for the well-being of the newly individuated fetal patient? The two-patient problem for the physician is seen to begin at the point of maternal refusal and is framed as a conflict between values of fetal benefit and maternal autonomy. The medical recommendation precipitating refusal is, presumably, unproblematic. But that presumption requires examination. Inherent in any conceptual shift is the potential for equivocation between the old paradigm and the new. If the physician's recommendation of fetal therapy incorporates one-patient thinking about the maternal-fetal relationship, questions about maternal refusal of that recommendation may be spurious, resting on a logically illicit hybrid of one-patient and two-patient conceptual schemes. We need, I think, to gain a fresh perspective on this issue by stepping back from the legal debate and considering in a systematic way how ethical guidelines for prenatal medical care are altered by transition to the two-patient obstetric model. …

Teenage pregnancy: Comparsion with two groups of older pregnant women

To evaluate the risk of adolescent pregnancies, we examined three groups of primigravidae in a prospective study from 1987 to 1988. A special protocol for the evaluation and follow-up of adolescent pregnancies was made. The rate of adolescent pregnancies was found to be two times higher between the years 1985 and 1987–1988. The pregnancy complications seen in the adolescent patients were equal to or lower than those found in older women. The cesarean section rate was also found to be lower in adolescent pregnancies. We conclude that sexual education programs are necessary for the reduction of teenage pregnancies and adequate medical prenatal care, as well as psychologic and social support, must be given to avoid both medical and psychologic problems for the sensitive young mother.

Unobservables, Pregnancy Resolutions, and Birth Weight Production Functions in New York City

This paper makes contributions to the estimation of health production functions and the economics of fertility control. We present the first infant health production functions that simultaneously control for self-selection in the resolution of pregnancies as live births or induced abortions and in the use of prenatal medical care services. We also incorporate the decision of a pregnant woman to give birth.

Epilepsy and pregnancy

Given the advantages of modern medical management, most pregnant epileptic women should experience no significant increase in seizure frequency. With good prenatal medical and obstetric care, complications of pregnancy and delivery in epileptic women differ little from those in the general population. In any case, monotherapy should be employed if possible, and anticonvulsant levels should be monitored closely during pregnancy and immediately after delivery. Dosage adjustments should be made appropriately. Since such an adjustment will usually be made in the second or third trimester, one would not expect it to produce an increased number of malformations. Trimethadione should be absolutely avoided and valproic acid used only with caution and with monitoring of alpha fetoprotein and uterine ultrasound. Although it is true that there is an increased incidence of malformations in children of epileptic women (with or without anticonvulsants), the great majority of these babies are normal. Vitamin K should be given to the mother before delivery, and the newborn should receive 1 mg vitamin K at birth. Unless the infant becomes symptomatic, breast feeding should be allowed. If seizures occur for the first time during pregnancy, the patient should be appropriately evaluated. Status epilepticus in pregnant women calls for aggressive and careful treatment. Finally, it should be remembered that oral contraceptives, especially the "mini pill," have a higher failure rate in women taking anticonvulsants. Discussing this problem with the patient is helpful.

Pregnant Teenagers: Deterrents to Service Use

This article reports the findings of a recent study of service use by pregnant adolescents. While medical prenatal care has gained increased acceptance among adolescents, nonmedical prenatal support services have been less successful in reaching this population. It is suggested that access, stigma, and informal support systems may be significant factors influencing service use. Further examination of the needs and desires of this population is required to enable service providers to develop appropriate and accessible programs that will reach and be reached by adolescents in need.

The Cost Effectiveness of Stopping Preterm Labor with Beta-Adrenergic Treatment

We retrospectively compared the costs of maternal and neonatal medical care after beta-adrenergic drug treatment, given to arrest preterm labor, with expected costs associated with no gestational delay. The treatment arrested labor for at least three days in 61 per cent of patients; gestation was extended by 14.1 +/- 1.1 weeks (mean +/- S.E.M.) in infants with the earliest gestational age at treatment (20 to 25 weeks) and by 2.3 +/- 0.7 weeks in those with the latest gestational age (36 to 37 weeks). Costs were based on hospital charges and physicians' fees, including high-risk obstetric outpatient charges, obstetric prenatal and delivery inpatient charges, and pediatric inpatient charges. Treatment provided between 26 and 33 weeks of gestation was clearly cost effective, resulting in expected savings of $11,240 (1981 dollars) per birth. After 33 weeks there was no substantial difference in expected costs with or without treatment. Between 20 and 25 weeks of gestation, the expected costs per surviving infant were $39,000 lower with treatment; however, the number of mothers who were not treated at this early stage of gestation (three patients) was too small to permit statistical significance. When the improved survival of infants after prenatal treatment was taken into account, treatment before 25 weeks was also cost effective. Thus, the increased costs of prenatal medical care were offset by decreased costs of neonatal medical care when treatment was given before 34 weeks of gestation.

Teenage obstetric complications.

Adolescent pregnancy is associated with a high degree of risk for the mother and her baby which may be mitigated by good prenatal care, intensive nutritional counseling, and attention to social problems. A study of 222 predominately black, single adolescents who delivered at the University of Tennessee Center for the Health Sciences during the 2-month period between December 1977 and February 1978 revealed an increased incidence of hypertension and convulsive disorders as well as a high rate of toxemia and fetal distress during labor and delivery. Birth weights of less than 2500 gm were associated with a 12% incidence of prematurity, and nearly 15% of the newborns required intensive care (23 had high-risk Apgar scores at 1 minute and 18 at 5 minutes). Perinatal mortality was 54/1000. In this population, teenage pregnancy is viewed as an accepted and even welcome occurrence, supporting the finding that poor neonatal care is a prime cause of the increased complications of adolescent pregnancy. Comprehensive personal services are required to achieve patient compliance with prenatal medical care.

Gastroesophageal reflux in the “near miss” sudden infant death syndrome

S U D D E N I N F A N T DEATH SYNDROME is the largest single cause of death between one week and one year of age. 1 Although there is no agreement about the cause of death, a number of epidemiologic factors have been associated with the syndrome. Surveys 1-' have shown that the peak age incidence occurs between two and four months and that there is a preponderance of male deaths. Death often occurs during periods of supposed sleep, but signs of a terminal struggle are frequently present. Some series note a preponderance of cases in the winter months, possibly related to an increased incidence of viral respiratory disease. The syndrome occurs more commonly in infants from a low socioeconomic environment; a history of cigarette smoking by the mother, young maternal age, and poor prenatal medical care are also common. Familial clustering of SIDS cases has been noted. 2 It has recently been emphasized that future SIDS victims have many abnormalities in body functions, especially respiration and feeding? There is another group of patients labeled near miss SIDS. These infants have sudden episodes of cyanosis and

Amniotic fluid infections in an african city

Amniotic fluid infections were the most common cause of perinatal death in Addis Ababa, Ethiopia (21.8/1,000 live births). Most such infections appear to originate in the fetal membranes near the cervical os. The high rate of spread of these local infections into the amniotic fluid in Addis Ababa appears related to a lack of antimicrobial activity in amniotic fluids. Factors that adversely affected nutrition in the gravid woman, lack of prenatal medical care, and low water usage were associated with the high rate of fatal infections.

Organization, Supervision, and Objectives of Prenatal Medical Care

Organization, Supervision, and Objectives of Prenatal Medical Care E. D. Plass CopyRight*Read before the Maternal and Child Health Section of the American Public Health Association at the Sixty-ninth Annual Meeting in Detroit, Mich., October 10, 1940. https://doi.org/10.2105/AJPH.31.9.964 Published Online: August 29, 2011