Are neonatal morbidities associated with no prenatal care different from those associated with inadequate prenatal care?


Objective: Compare neonatal morbidities in women with no prenatal care, and women with inadequate prenatal care, to those with adequate prenatal care. Methods: Retrospective cohort study of neonatal morbidities of 3 exposure groups. Group 1: No prenatal care; Group 2: Inadequate prenatal care; Group 3: Intermediate/adequate prenatal care. Results: 2.5%, 23.3% and 74.1% of subjects (N = 264,138) were in Groups 1, 2 and 3 respectively. Severe neonatal morbidity was more common in Group 1, followed by Group 2, and least common in Group 3. After controlling for gestational age and birth weight, most of these differences were attenuated and not significant except for the following Group 1 vs Group 3 comparisons: meconium aspiration, odds ratio (OR) 2.15 and 95% confidence interval (CI) 1.39 - 3.33; suspected sepsis, OR 1.30 and CI 1.13 - 1.49; proven viral sepsis, OR 2.23 and CI 1.24 - 4.00. Conclusions: Severe neonatal morbidity was most common in those with no prenatal care followed by those with inadequate prenatal care. For most neonatal morbidities, this could largely be explained by gestational age and birth weight differences, but for some neonatal morbidities (meconium aspirations, viral sepsis and dysmorphic features) the impact of no prenatal care persisted after adjustment for these factors.

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M. Okoroh, E. , V. Coonrod, D. , Chapple, K. and Drachman, D. (2012) Are neonatal morbidities associated with no prenatal care different from those associated with inadequate prenatal care?. Open Journal of Obstetrics and Gynecology, 2, 89-97. doi: 10.4236/ojog.2012.22018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hogan, M.C., Foreman, K.J., Naghavi, M., Ahn, S.Y., Wang, M., Makela, S.M., Lopez, A.D., Lozano, R. and Murray, C.J. (2010) Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet, 375, 1609-1623. doi:10.1016/S0140-6736(10)60518-1
[2] Moccia, P. and Anthony, D., Eds. (2009) The state of the world’s children. United Nations Children’s Fund (UNICEF), New York.
[3] Leveno, K.J., Cunningham, F.G., Roark, M.L., Nelson, S.D. and Williams, M.L. (1985) Prenatal care and the low birth weight infant. Obstetrics & Gynecology, 66, 599-605.
[4] Kessner, D.M., Singer, J. and Kalk, C.W. (1973) Infant death: An analysis by maternal risk and health care. In: Contrasts in Health Status, 1, Institute of Medicine and National Academy of Sciences, Washington DC.
[5] Kotelchuck, M. (1994) An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84, 1414-1420. doi:10.2105/AJPH.84.9.1414
[6] Alexander, G.R. and Cornely, D.A. (1987) Prenatal care utilization: Its measurement and relationship to pregnancy outcome. American Journal of Preventive Medicine, 3, 243-253.
[7] Raatikainen, K., Heiskanen, N. and Heinonen, S. (2007) Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health, 7, 268. doi:10.1186/1471-2458-7-268
[8] Williams, J.W. (1915) The limitations and possibilities of prenatal care. Based on the study of 705 fetal deaths occurring in 10,000 consecutive admissions to the obstetrical department of the Johns Hopkins Hospital. The Journal of the American Medical Association, 64, 95. doi:10.1001/jama.1915.02570280001001
[9] Eastman, N.J. (1947) Prematurity from the viewpoint of the obstetrician. American Practitioner and Digest of Treatment, 1, 343-352.
[10] Tokuhata, G.K., Digon, E. and Mann, L. (1973) Prenatal care and obstetric abnormalities. Experiences of 185,000 Pennsylvania births. Journal of Chronic Diseases, 26, 163-185. doi:10.1016/0021-9681(73)90088-X
[11] Debiec, K.E., Paul, K.J., Mitchell, C.M. and Hitti, J.E. (2010) Inadequate prenatal care and risk of preterm delivery among adolescents: A retrospective study over 10 years. American Journal of Obstetrics & Gynecology, 203, 122.e1-e6.
[12] McCaw-Binns, A., La Grenade, J. and Ashley, D. (1995) Under-users of antenatal care: A comparison of non-attenders and late attenders for antenatal care, with early attenders. Social Science & Medicine, 40, 1003-1012. doi:10.1016/0277-9536(94)00175-S
[13] Blondel, B. and Marshall, B. (1998) Poor antenatal care in 20 French districts: Risk factors and pregnancy outcome. Journal of Epidemiology & Community Health, 52, 501-506. doi:10.1136/jech.52.8.501
[14] Delvaux, T., Buekens, P., Godin, I. and Boutsen, M. (2001) Barriers to prenatal care in Europe. American Journal of Preventive Medicine, 21, 52-59. doi:10.1016/S0749-3797(01)00315-4
[15] Kupek, E., Petrou, S., Vause, S. and Maresh, M. (2002) Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales. British Journal of Obstetrics and Gynaecology, 109, 265-273. doi:10.1111/j.1471-0528.2002.00524.x
[16] Gissler, M. and Hemminki, E. (1994) Amount of antenatal care and infant outcome. European Journal of Obstetrics & Gynecology and Reproductive Biology, 56, 9-14. doi:10.1016/0028-2243(94)90146-5
[17] Vintzileos, A.M., Ananth, C.V., Smulian, J.C., Scorza, W.E. and Knuppel, R.A. (2002) The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. American Journal of Obstetrics and Gynecology, 186, 1011-1016. doi:10.1067/mob.2002.122446
[18] Chen, X.K., Wen, S.W., Yang, Q. and Walker, M.C. (2007) Adequacy of prenatal care and neonatal mortality in infants born to mothers with and without antenatal highrisk conditions. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47, 122-127. doi:10.1111/j.1479-828X.2007.00697.x
[19] Herbst, M.A., Mercer, B.M., Beazley, D., Meyer, N. and Carr, T. (2003) Relationship of prenatal care and perinatal morbidity in low-birth-weight infants. American Journal of Obstetrics and Gynecology, 189, 930-933. doi:10.1067/S0002-9378(03)01055-X
[20] Moore, P.D., Bay, R.C., Balcazar, H., Coonrod, D.V., Brady, J. and Russ, R. (2005) Use of home visit and developmental clinic services by high risk Mexican-American and white non-Hispanic infants. Maternal and Child Health Journal, 9, 35-47. doi:10.1007/s10995-005-2449-1
[21] Kotelchuck, M. (1994) The adequacy of prenatal care utilization index: Its US distribution and association with low birthweight. American Journal of Public Health, 84, 1486-1489. doi:10.2105/AJPH.84.9.1486
[22] Forrest, J.D. and Singh, S. (1987) Timing of prenatal care in the United States: How accurate are our measurements? Health Services Research, 22, 235-253.
[23] Fiscella, K. (1995) Does prenatal care improve birth outcomes? A critical review. Obstetrics & Gynecology, 85, 468-479. doi:10.1016/0029-7844(94)00408-6
[24] Markides, K.S. and Coreil, J. (1986) The health of hispanics in the southwestern United States: An epidemiologic paradox. Public Health Reports, 101, 253-265.
[25] Chung, J.H., Boscardin, W.J., Garite, T.J., Lagrew, D.C. and Porto, M. (2003) Ethnic differences in birth weight by gestational age: At least a partial explanation for the Hispanic epidemiologic paradox? American Journal of Obstetrics and Gynecology, 189, 1058-1062. doi:10.1067/S0002-9378(03)00848-2
[26] Coonrod, D.V., Bay, R.C. and Balcazar, H. (2004) Ethnicity, acculturation and obstetric outcomes. Different risk factor profiles in lowand high-acculturation Hispanics and in white non-Hispanics. The Journal of Reproductive Medicine, 49, 17-22.
[27] Nothnagle, M., Marchi, K., Egerter, S. and Braveman, P. (2000) Risk factors for late or no prenatal care following Medicaid expansions in California. Maternal and Child Health Journal, 4, 251-259. doi:10.1023/A:1026647722295
[28] Health Care and Education Reconciliation Act of 2010 (2010) Public Law 111-152, 124 Stat. 1029-1083.

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