Skip to main content

Preventing Low Birthweight (1985) / Chapter Skim
Currently Skimming:

6. The Effectiveness of Prenatal Care
Pages 132-149

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 132...
... It is possible that it is not prenatal care itself that increases the chances of a normal birthweight infant, but rather the other characteristics usually found in women who obtain such care, including optimal childbearing age, high level of education, being married, and income above the poverty line. Conversely, women who do not receive adequate prenatal care may deliver infants of low birthweight because they are characterized by other risk factors, such as extreme youth or age, poor education, being unmarried, or low income (Chapter 21.
From page 133...
... Researchers are aware, however, that the task of determining the effectiveness of prenatal care in the prevent ion of low birthweight, as well as other poor pregnancy outcomes, is complicated by a variety of problems. Research Des ign The f i rst problem is the ethical barr ier to conducting randomized clinical trials , which are considered the best source of evidence on the efficacy of a medical procedure.
From page 134...
... This confounding of cause and effect has been addressed in a number of ways. Ressner, most notably, developed a prenatal care index based on number of prenatal visits in relation to duration of pregnancy, the interval to the f irst visit, and type of hospital delivery service (private or general)
From page 135...
... The existence of such problems is substantiated by a 1972 National Natality Survey study in which reporting of the number of prenatal visits on birth certificates was compared with survey data.~° Perfect agreement was found in only 16 percent of the cases. Land and Vaughan reviewed Missouri 1980 birth certificate data completed in hospitals using different sources of data.
From page 136...
... Their knowledge and good health habits mav held to Protect their babies from low birthweight. ~ _^ , Hungary, cle ~ ay in seeking care suggests selection bias as well.
From page 137...
... Most, though not all of them, focus on low income, largely minority populations. Women in these populations are at elevated risk of delivering a low birthweight infant; but no effort has been made to determine whether programs judged ineffective for these high-risk women might be effective in reducing low b~rthweight in a lower isk population.
From page 138...
... In addition, he noted that inadequate care was more frequently associated with low birthweight for white mothers who delivered in a genera' (nonpr ivate) service and for all black mothers.
From page 139...
... birth certificates, controlling for race and maternal education, and found a significant relationship between no prenatal care and the incidence of low birthweight The absence of prenatal care had the greatest effect among black, less-educated women. Unfortunately, neither Eisner et al., Taffel, nor Greenberg controlled for gestational age in their analyses.
From page 140...
... When a modified version of the Ressner measure of the adequacy of care was used, elimination of non-adequate care reduced the low birthweight risk by 15 percent among whites and by 12 percent among blacks. The sensitivity of the results to differences in the method of measuring prenatal care suggests that the pattern of care is more significant than merely when care begins.
From page 141...
... Enrollment for prenatal care ~ n the f irst tr imester was the same in both groups, but a significantly higher percentage of HMO patients had 11 or more visits. Although the two groups had no statistically significant differences in outcomes, including low birthweight infants, the findings suggest a positive impact of prenatal care since the EIMO group had a higher proportion of high-risk women.
From page 143...
... evaluated the effects for the period July 1, 1979, to August 30, 1981, by comparing the pregnancy outcomes of (1} all black women In the two counties served by the IPO program with those of all black women in two neighboring counties of similar socioeconomic composition; (2 ~ all black women in the IPO counties who actually registered in the IPO program with those of all black women in the comparison counties; and {3) all black teenage IPO registrants with those of all black teenagers in the comparison counties.29 On the basis of data from vital statistics, the investigators reported that the adequacy of prenatal care, as measured by an adaptation of the Kessner index, was significantly improved in all three IPO groups They did not, however , find a corresponding decrease in the incidence of low birthweight.
From page 144...
... They found a reduced incidence of low birthweight in the group served by nurse-midwives, but were uncertain whether this effect was due to the program per se. Moreover, because the nurse-midwives were providing care in an area that had a growing lack of providers generally, the study is more an anlysis of the effect on pregnancy of some care versus no care.33 OB Access The Obstetrical Access Pilot Project (OB Access)
From page 145...
... Some routine diagnostic screening was financed, but not to the extent offered in the OB Access projecte Evaluators of the OB Access Project compared project participants with a group of women whose prenatal care was reimbursed through the Medi-Cal program, matched by race/ethn~city, maternal age, par ity, plurality, sex of infant, and county of residence.36 They reported that the incidence of low birthweight was 4.7 percent for OB Access births and 7.1 percent for the Medi-Cal births. The rate of very low birthweight (less than 1,500 grams)
From page 146...
... For example, the care may not have focused on such factors as smoking reduction, adequate weight gain, reducing alcohol and other substance abuse, patient and provider education about prevention of prematurity, or specific medical risks associated with low birthweight, such as bacteriuria. · Unfortunately, evaluations of the smaller, more specialized programs suffer from the usual problems of studies based on quasi-experimental designs, such as self-selection and problems i n obtaining suitable comparison groups.
From page 147...
... 10. National Center for Health Statistics: Comparability of Reporting Between the Birth Certificate and the National Natality Survey.
From page 148...
... 17. Eisner V, Brazie JV, Pratt MW, and Hexter AC: The risk of low birthweight.
From page 149...
... 31. Schwartz R and Poppen P: Measuring the Impact of CHCS on Pregnancy outcomes: Final Report.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.