Abstract
Objective
Lack of or no prenatal care (NPC) is associated with preterm birth (PTB) and low birth
weight (LBW). Our purpose was to determine whether LBW infants delivered after NPC
have worse outcomes than LBW infants with prenatal care (PC).
Study design
Eight thousand sixty-five consecutive women delivered at six hospitals in Shelby County,
Tenn, were evaluated regarding clinical characteristics and perinatal outcomes depending
on the occurrence of PC. Infant and LBW infant outcomes were evaluated on the basis
of the occurrence of PC. Multivariate analysis was performed for neonatal outcomes
adjusting for race, plurality, antenatal steroids, amnionitis, and ponderal index.
A P value less than .05 was considered significant.
Results
NPC women were more likely multiparous (80% vs 65%), African American (70% vs 61%),
and uninsured (25% vs 4%), P<.0001 for each. PTB (36% vs 15%) and LBW (22% vs 12%) were more common with NPC,
P<.0001 for each. Women with NPC had more advanced cervical dilation (ACD) greater
than 4 cm (ACD: 63% vs 39%) and more amnionitis on admission (2% vs 1%), P≤.001 for each, and had more fetal distress in labor, P = .02. NPC infants had increased mortality, respiratory distress syndrome, intraventricular
hemorrhage, retinopathy, and bronchopulmonary dysplasia. Among LBW infants, NPC was
associated with premature rupture of membranes, antepartum hemorrhage, amnionitis,
and ACD. Controlling for other factors, NPC LBW infants had increased mortality (17%
vs 9%), respiratory distress syndrome (31% vs 24%), intraventricular hemorrhage (10%
vs 5%), retinopathy (13% vs 9%), and bronchopulmonary dysplasia (11% vs 7%), P≤.04 for each.
Conclusion
In addition to increasing PTB and LBW, NPC is associated with increased perinatal
morbidity and mortality among LBW infants after controlling for confounding factors.
Keywords
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References
- Prenatal care, prematurity, and neonatal mortality.Am J Obstet Gynecol. 1932; 83: 591-598
- The effect of prenatal care upon the health of the newborn.Am J Public Health. 1979; 69: 653-657
- The impact of prenatal care in different social groups.Am J Obstet Gynecol. 1983; 145: 797-801
- Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation.Am J Public Health. 1984; 74: 1003-1008
- The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions.Am J Obstet Gynecol. 2002; 186: 1011-1016
- Preterm premature rupture of the membranes.Obstet Gynecol. 2003; 101: 178-193
- Effect of prenatal care on obstetrical outcome.J Matern Fetal Med. 1996; 5: 142-150
- Prenatal care utilization: its measurement and relationship to pregnancy outcome.Am J Prev Med. 1987; 3: 243-253
- Some factors influencing prenatal care.N Engl J Med. 1965; 265: 1
- An evaluation of prenatal care and its relationship to social class and social disorganization.Am J Public Health. 1953; 43: 1001-1010
- Antenatal care and maternal demographic and social characteristics: evolution in France between 1972 and 1976.J Epidemiol Community Health. 1980; 34: 157-163
Article Info
Publication History
Cleveland, Ohio, and Memphis, Tenn
Footnotes
☆Supported by the Prematurity Center of the Partnership for Women's and Children's Health (University of Tennessee, Memphis, Methodist Healthcare Foundation, LeBonheur Children's Hospital, and the Tennessee Coordinated Care Network), and in part by a grant from the National Center for Research Resources (M01-RR-000080).
☆Presented at the Twenty-Third annual meeting of the Society for Maternal-Fetal Medicine, San Francisco, Calif, February 3-8, 2003.
☆Reprints not available from the authors.
Identification
Copyright
© 2003 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
