Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices

被引：100
作者：
Heaman M.I. [1 ,2 ,5 ]
Newburn-Cook C.V. [3 ]
Green C.G. [4 ,5 ]
Elliott L.J. [5 ,6 ]
Helewa M.E. [2 ]
机构：
[1] Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg
[2] Department of Obstetrics, Gynecology, and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB
[3] Faculty of Nursing, University of Alberta, Edmonton, AB
[4] Manitoba Agriculture, Food and Rural Initiatives, Winnipeg, MB
[5] Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB
[6] Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB
来源：
BMC Pregnancy and Childbirth | / 8卷 / 1期
关键词：
Preterm Birth; Prenatal Care; Birth Outcome; Adverse Pregnancy Outcome; Prenatal Care Utilization;
D O I：
10.1186/1471-2393-8-15
中图分类号：
学科分类号：
摘要：
Background: The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes (preterm birth, low birth weight [LBW], and small-for-gestational age [SGA]), using each of the indices; and, to assess whether or not, and to what extent, gestational age modifies this association. Methods: We conducted a population-based study of women having a hospital-based singleton live birth from 1991 to 2000 (N = 80,989). Data sources consisted of a linked mother-baby database and a physician claims file maintained by Manitoba Health. Rates of inadequate prenatal care were calculated using two indices, the R-GINDEX and the APNCU. Logistic regression analysis was used to determine the association between inadequate prenatal care and adverse pregnancy outcomes. Stratified analysis was then used to determine whether the association between inadequate prenatal care and LBW or SGA differed by gestational age. Results: Rates of inadequate/no prenatal care ranged from 8.3% using APNCU to 8.9% using R-GINDEX. The association between inadequate prenatal care and preterm birth and LBW varied depending on the index used, with adjusted odds ratios (AOR) ranging from 1.0 to 1.3. In contrast, both indices revealed the same strength of association of inadequate prenatal care with SGA (AOR 1.4). Both indices demonstrated heterogeneity (non-uniformity) across gestational age strata, indicating the presence of effect modification by gestational age. Conclusion: Selection of a prenatal care utilization index requires careful consideration of its methodological underpinnings and limitations. The two indices compared in this study revealed different patterns of utilization of prenatal care, and should not be used interchangeably. Use of these indices to study the association between utilization of prenatal care and pregnancy outcomes affected by the duration of pregnancy should be approached cautiously. © 2008 Heaman et al; licensee BioMed Central Ltd.
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  • [1] Kogan MD(1998)The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices Jama 279 1623-1628
  • [2] Martin JA(1994)An Evaluation of the Kessner Adequacy of Prenatal-Care Index and A Proposed Adequacy of Prenatal-Care Utilization Index Am J Public Health 84 1414-1420
  • [3] Alexander GR(1987)Prenatal care utilization: its measurement and relationship to pregnancy outcome Am J Prev Med 3 243-253
  • [4] Kotelchuck M(1996)Quantifying the adequacy of prenatal care: A comparison of indices Public Health Rep 111 408-418
  • [5] Ventura SJ(2001)Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research Public Health Rep 116 306-316
  • [6] Frigoletto FD(1996)Prenatal care and prevention of preterm birth. A case-control study in southern Spain Eur J Epidemiol 12 37-44
  • [7] Kotelchuck M(1996)Role of prenatal care in preterm birth and low birthweight in Portugal J Public Health Med 18 321-328
  • [8] Alexander GR(2000)Adequacy of prenatal care and pregnancy outcome J Am Osteopath Assoc 100 485-492
  • [9] Cornely DA(2005)Risk factors for spontaneous preterm birth among Aboriginal and non-Aboriginal women in Manitoba Paediatr Perinat Epidemiol 19 181-193
  • [10] Alexander GR(2003)Prenatal care reduces the impact of illicit drug use on perinatal outcomes J Perinatol 23 354-360
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