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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2008

Open Access 01-12-2008 | Research article

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

Authors: Maureen I Heaman, Christine V Newburn-Cook, Chris G Green, Lawrence J Elliott, Michael E Helewa

Published in: BMC Pregnancy and Childbirth | Issue 1/2008

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Abstract

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.
Appendix
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Metadata
Title
Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices
Authors
Maureen I Heaman
Christine V Newburn-Cook
Chris G Green
Lawrence J Elliott
Michael E Helewa
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2008
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-8-15

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