Application of the Kessner and Kotelchuck Prenatal Care Adequacy Indices in a Preterm Birth Population

Objectives Healthy People 2010 goals to eliminate racial and ethnic health disparities that persist in the utilization of prenatal care (PNC) highlight the importance of measuring PNC as a variable in maternal and infant health outcomes research. These disparities are significantly correlated to adverse infant outcomes in preterm birth (PTB), a leading cause of infant mortality and life-long morbidity. Currently the most extensively used PNC adequacy indices (Kessner and Kotelchuck) were developed to measure outcomes in populations consisting mostly of full-term births. It is unclear whether these PNC adequacy indices are reliable when pregnancy is truncated due to PTB (< 37 weeks). This paper compares and demonstrates how they can be applied in a specific PTB cohort. Design and Sample This secondary analysis of a nested case-control study compares Kessner and Kotelchuck adequacy scores of 367 mothers of PTB infants. Results There were significant differences in the rating of PNC inadequacy ( p <.001) depending on the PNC adequacy index used. Conclusion Critical evaluation is warranted before using these PNC adequacy indices in future public health nursing and PTB research.