Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1994 Sep;84(9):1450–1457. doi: 10.2105/ajph.84.9.1450

The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada.

C A Mustard 1, N P Roos 1
PMCID: PMC1615180  PMID: 8092370

Abstract

OBJECTIVES. Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. METHODS. Measures of prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12,646 pregnant women. Maternal socioeconomic status was derived from small-area census data. RESULTS. Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The difference in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was no greater among women with pregnancy complications. CONCLUSIONS. The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care.

Full text

PDF
1450

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander G. R., Cornely D. A. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prev Med. 1987 Sep-Oct;3(5):243–253. [PubMed] [Google Scholar]
  2. Alexander G. R., Tompkins M. E., Petersen D. J., Weiss J. Source of bias in prenatal care utilization indices: implications for evaluating the Medicaid expansion. Am J Public Health. 1991 Aug;81(8):1013–1016. doi: 10.2105/ajph.81.8.1013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Anderson G. M., Grumbach K., Luft H. S., Roos L. L., Mustard C., Brook R. Use of coronary artery bypass surgery in the United States and Canada. Influence of age and income. JAMA. 1993 Apr 7;269(13):1661–1666. [PubMed] [Google Scholar]
  4. Carey T. S., Weis K., Homer C. Prepaid versus traditional Medicaid plans: lack of effect on pregnancy outcomes and prenatal care. Health Serv Res. 1991 Jun;26(2):165–181. [PMC free article] [PubMed] [Google Scholar]
  5. Chng P. K., Hall M. H., MacGillivray I. An audit of antenatal care: the value of the first antenatal visit. Br Med J. 1980 Nov 1;281(6249):1184–1186. doi: 10.1136/bmj.281.6249.1184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooney J. P. What determines the start of prenatal care? Prenatal care, insurance, and education. Med Care. 1985 Aug;23(8):986–997. doi: 10.1097/00005650-198508000-00006. [DOI] [PubMed] [Google Scholar]
  7. Eisner V., Brazie J. V., Pratt M. W., Hexter A. C. The risk of low birthweight. Am J Public Health. 1979 Sep;69(9):887–893. doi: 10.2105/ajph.69.9.887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fisher E. S., LoGerfo J. P., Daling J. R. Prenatal care and pregnancy outcomes during the recession: the Washington State experience. Am J Public Health. 1985 Aug;75(8):866–869. doi: 10.2105/ajph.75.8.866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gortmaker S. L. The effects of prenatal care upon the health of the newborn. Am J Public Health. 1979 Jul;69(7):653–660. doi: 10.2105/ajph.69.7.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Greenberg R. S. The impact of prenatal care in different social groups. Am J Obstet Gynecol. 1983 Apr 1;145(7):797–801. doi: 10.1016/0002-9378(83)90681-6. [DOI] [PubMed] [Google Scholar]
  11. Guyer B. Medicaid and prenatal care. Necessary but not sufficient. JAMA. 1990 Nov 7;264(17):2264–2265. [PubMed] [Google Scholar]
  12. Hall M. H., Chng P. K., MacGillivray I. Is routine antenatal care worth while? Lancet. 1980 Jul 12;2(8185):78–80. doi: 10.1016/s0140-6736(80)92950-5. [DOI] [PubMed] [Google Scholar]
  13. Hansell M. J. Sociodemographic factors and the quality of prenatal care. Am J Public Health. 1991 Aug;81(8):1023–1028. doi: 10.2105/ajph.81.8.1023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Howell E. M., Herz E. J., Wang R. H., Hirsch M. B. A comparison of Medicaid and non-Medicaid obstetrical care in California. Health Care Financ Rev. 1991 Summer;12(4):1–15. [PMC free article] [PubMed] [Google Scholar]
  15. Ingram D. D., Makuc D., Kleinman J. C. National and state trends in use of prenatal care, 1970-83. Am J Public Health. 1986 Apr;76(4):415–423. doi: 10.2105/ajph.76.4.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Konte J. M., Creasy R. K., Laros R. K., Jr California North Coast Preterm Birth Prevention project. Obstet Gynecol. 1988 May;71(5):727–730. [PubMed] [Google Scholar]
  17. Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992 May;82(5):703–710. doi: 10.2105/ajph.82.5.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Leppert P. C., Namerow P. B., Barker D. Pregnancy outcomes among adolescent and older women receiving comprehensive prenatal care. J Adolesc Health Care. 1986 Mar;7(2):112–117. doi: 10.1016/s0197-0070(86)80006-7. [DOI] [PubMed] [Google Scholar]
  19. Lieberman E., Ryan K. J., Monson R. R., Schoenbaum S. C. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med. 1987 Sep 17;317(12):743–748. doi: 10.1056/NEJM198709173171206. [DOI] [PubMed] [Google Scholar]
  20. Logue E. E., Jarjoura D. Modeling heart disease mortality with census tract rates and social class mixtures. Soc Sci Med. 1990;31(5):545–550. doi: 10.1016/0277-9536(90)90089-b. [DOI] [PubMed] [Google Scholar]
  21. Lumley J. The prevention of preterm birth: unresolved problems and work in progress. Aust Paediatr J. 1988 Apr;24(2):101–111. doi: 10.1111/j.1440-1754.1988.tb00298.x. [DOI] [PubMed] [Google Scholar]
  22. McCormick M. C. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985 Jan 10;312(2):82–90. doi: 10.1056/NEJM198501103120204. [DOI] [PubMed] [Google Scholar]
  23. McLaughlin C. G., Normolle D. P., Wolfe R. A., McMahon L. F., Jr, Griffith J. R. Small-area variation in hospital discharge rates. Do socioeconomic variables matter? Med Care. 1989 May;27(5):507–521. doi: 10.1097/00005650-198905000-00006. [DOI] [PubMed] [Google Scholar]
  24. Miller C. L., Margolis L. H., Schwethelm B., Smith S. Barriers to implementation of a prenatal care program for low income women. Am J Public Health. 1989 Jan;79(1):62–64. doi: 10.2105/ajph.79.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Murray J. L., Bernfield M. The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan. N Engl J Med. 1988 Nov 24;319(21):1385–1391. doi: 10.1056/NEJM198811243192105. [DOI] [PubMed] [Google Scholar]
  26. Oakley A., Rajan L., Grant A. Social support and pregnancy outcome. Br J Obstet Gynaecol. 1990 Feb;97(2):155–162. doi: 10.1111/j.1471-0528.1990.tb01741.x. [DOI] [PubMed] [Google Scholar]
  27. Papiernik E., Bouyer J., Dreyfus J., Collin D., Winisdorffer G., Guegen S., Lecomte M., Lazar P. Prevention of preterm births: a perinatal study in Haguenau, France. Pediatrics. 1985 Aug;76(2):154–158. [PubMed] [Google Scholar]
  28. Peoples M. D., Grimson R. C., Daughtry G. L. Evaluation of the effects of the North Carolina Improved Pregnancy Outcome Project: implications for state-level decision-making. Am J Public Health. 1984 Jun;74(6):549–554. doi: 10.2105/ajph.74.6.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Peoples M. D., Siegel E. Measuring the impact of programs for mothers and infants on prenatal care and low birth weight: the value of refined analyses. Med Care. 1983 Jun;21(6):586–608. doi: 10.1097/00005650-198306000-00002. [DOI] [PubMed] [Google Scholar]
  30. Piper J. M., Ray W. A., Griffin M. R. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA. 1990 Nov 7;264(17):2219–2223. [PubMed] [Google Scholar]
  31. Quick J. D., Greenlick M. R., Roghmann K. J. Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis. Am J Public Health. 1981 Apr;71(4):381–390. doi: 10.2105/ajph.71.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Rosenberg S. N., Albertsen P. C., Jones E. E., Roberts R. S. Complications of labor and delivery following uncomplicated pregnancy. Med Care. 1981 Jan;19(1):68–79. doi: 10.1097/00005650-198101000-00008. [DOI] [PubMed] [Google Scholar]
  33. SHWARTZ S., VINYARD J. H., Jr PRENATAL CARE AND PREMATURITY. Public Health Rep. 1965 Mar;80:237–248. [PMC free article] [PubMed] [Google Scholar]
  34. Satin M. S., Monetti C. H. Census tract predictors of physical, psychological, and social functioning for needs assessment. Health Serv Res. 1985 Aug;20(3):341–358. [PMC free article] [PubMed] [Google Scholar]
  35. Savitz D. A., Whelan E. A., Kleckner R. C. Effect of parents' occupational exposures on risk of stillbirth, preterm delivery, and small-for-gestational-age infants. Am J Epidemiol. 1989 Jun;129(6):1201–1218. doi: 10.1093/oxfordjournals.aje.a115241. [DOI] [PubMed] [Google Scholar]
  36. Scholl T. O., Miller L. K., Salmon R. W., Cofsky M. C., Shearer J. Prenatal care adequacy and the outcome of adolescent pregnancy: effects on weight gain, preterm delivery, and birth weight. Obstet Gynecol. 1987 Mar;69(3 Pt 1):312–316. [PubMed] [Google Scholar]
  37. Shiono P. H., Klebanoff M. A., Graubard B. I., Berendes H. W., Rhoads G. G. Birth weight among women of different ethnic groups. JAMA. 1986 Jan 3;255(1):48–52. [PubMed] [Google Scholar]
  38. Showstack J. A., Budetti P. P., Minkler D. Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation. Am J Public Health. 1984 Sep;74(9):1003–1008. doi: 10.2105/ajph.74.9.1003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Stockbauer J. W. WIC prenatal participation and its relation to pregnancy outcomes in Missouri: a second look. Am J Public Health. 1987 Jul;77(7):813–818. doi: 10.2105/ajph.77.7.813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Thomas P., Golding J., Peters T. J. Delayed antenatal care: does it effect pregnancy outcome? Soc Sci Med. 1991;32(6):715–723. doi: 10.1016/0277-9536(91)90151-2. [DOI] [PubMed] [Google Scholar]
  41. Tyson J., Guzick D., Rosenfeld C. R., Lasky R., Gant N., Jiminez J., Heartwell S. Prenatal care evaluation and cohort analyses. Pediatrics. 1990 Feb;85(2):195–204. [PubMed] [Google Scholar]
  42. Wilkins R. Use of postal codes and addresses in the analysis of health data. Health Rep. 1993;5(2):157–177. [PubMed] [Google Scholar]
  43. Wissow L. S., Gittelsohn A. M., Szklo M., Starfield B., Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988 Jul;78(7):777–782. doi: 10.2105/ajph.78.7.777. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES