Background: Health policies that seek to improve pregnancy outcomes focus on increasing the availability and access to prenatal care (PNC) services based on studies that support an association between insufficient PNC and adverse birth outcomes. These studies employ PNC utilization indices that measure the adequacy of PNC use, but these indices fail to account for the content or specific components of PNC. Objectives: The purpose of this study was to utilize PRAMS and birth certificate data to evaluate the content and quality of PNC in Virginia, and its impact on preterm birth and maternal postpartum health behaviors. Methods: Data was from the 2007 Virginia Pregnancy Risk Assessment Monitoring System (PRAMS). This population-based data is representative of all Virginia women who have had a live birth recently and included 1,236 female participants. Results: Inadequate PNC was associated with nearly a three-fold increase in risk of low birth weight (OR = 2.8, 95% CI = 1.5, 5.2), but not preterm birth. Women with adequate plus PNC were more likely to deliver infants who were preterm (OR = 10.2, 95% CI = 4.3, 24.4) and low birth weight (OR = 6.3, 95% CI = 4.2, 9.4). After adjusting for method of payment, income, and reported problems during pregnancy, women with lower income and no private insurance were more likely to have inadequate PNC (OR = 1.4, 95% CI = 0.5, 4.1) and (OR = 8.8, 95% CI = 1.3, 59.8), respectively. Provider discussions were not different based on adequacy of PNC. In addition, among women who received adequate PNC, those whose providers discussed postpartum birth control use were 4.5 times more likely to use birth control after delivery compared to women who did not receive education (95% CI=1.7, 11.8). Conclusion: The lack of strong associations between adequacy of PNC and birth outcomes indicate that there are other factors (intergenerational, stress, cultural) that may play a more prominent role in predicting maternal and infant health.
| Identifer | oai:union.ndltd.org:vcu.edu/oai:scholarscompass.vcu.edu:etd-3078 |
| Date | 07 May 2010 |
| Creators | Cha, Susan |
| Publisher | VCU Scholars Compass |
| Source Sets | Virginia Commonwealth University |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Theses and Dissertations |
| Rights | © The Author |
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