Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1981 Apr;71(4):381–390. doi: 10.2105/ajph.71.4.381

Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis.

J D Quick, M R Greenlick, K J Roghmann
PMCID: PMC1619678  PMID: 7468878

Abstract

We studied the use of prenatal care and pregnancy outcome in 4,148 deliveries among members of a well-established health maintenance organization (HMO) and 19,116 births among the 1973-1974 White birth cohort in the Portland, Oregon area. Mothers in the HMO were almost one year older on the average, slightly better educated, and less frequently unmarried, but had virtually identical past pregnancy histories when compared with the general population cohort. HMO members began prenatal care one month later and had three fewer visits than the general population (p less than .01); 78 per cent of the general population and only 64 per cent of HMO members began prenatal care in the first trimester (p less than .01). With maternal risk held constant, low birthweight, neonatal mortality, and infant mortality were 1.5 to 5 times greater with late, less frequent prenatal care than with early, frequent care. Multivariate analysis demonstrated a positive relationship between prenatal care and birthweight. Although this relationship was independent of risk factors recorded on birth certificates, it is not necessarily a causal relationship. Unadjusted prematurity, neonatal and infant mortality rates did not differ between the HMO and general populations. Multivariate analyses indicated that, independent of all maternal risk factors, HMO membership was associated with an increase of 30 grams in the predicted birthweight (P less than .01), but had no effect on mortality. The data suggest that, in Portland, Oregon, pregnancy outcome for HMO members is comparable to that of the general population.

Full text

PDF
381

Selected References

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

  1. Aubry R. H., Nesbitt R. E., Jr High risk obstetrics. I. Perinatal outcome in relation to a broadened approach to obstetric care for patients at special risk. Am J Obstet Gynecol. 1969 Sep 15;105(2):241–247. [PubMed] [Google Scholar]
  2. Bergner L., Susser M. W. Low birth weight and prenatal nutrition: an interpretative review. Pediatrics. 1970 Dec;46(6):946–966. [PubMed] [Google Scholar]
  3. Coopland A. T., Peddle L. J., Baskett T. F., Rollwagen R., Simpson A., Parker E. A simplified antepartum high-risk pregnancy scoring form: statistical analysis of 5459 cases. Can Med Assoc J. 1977 May 7;116(9):999–1001. [PMC free article] [PubMed] [Google Scholar]
  4. David R. J. The quality and completeness of birthweight and gestational age data in computerized birth files. Am J Public Health. 1980 Sep;70(9):964–973. doi: 10.2105/ajph.70.9.964. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. DeGeorge F. V., Nesbitt R. E., Jr, Aubry R. H. High-risk obstetrics. VI. An evaluation of the effects of intensified care on pregnancy outcome. Am J Obstet Gynecol. 1971 Nov 1;111(5):650–657. [PubMed] [Google Scholar]
  6. Ellwood P. M., Jr, Anderson N. N., Billings J. E., Carlson R. J., Hoagberg E. J., McClure W. Health maintenance strategy. Med Care. 1971 May-Jun;9(3):291–298. doi: 10.1097/00005650-197105000-00008. [DOI] [PubMed] [Google Scholar]
  7. Frost F., Shy K. K. Racial differences between linked birth and infant death records in Washington State. Am J Public Health. 1980 Sep;70(9):974–976. doi: 10.2105/ajph.70.9.974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. Greenlick M. R., Freeborn D. K., Gambill G. L., Pope C. R. Determinants of medical care utilization: the role of the telephone in total medical care. Med Care. 1973 Mar-Apr;11(2):121–134. doi: 10.1097/00005650-197303000-00004. [DOI] [PubMed] [Google Scholar]
  10. Hemminki E., Starfield B. Prevention of low birth weight and pre-term birth: literature review and suggestions for research policy. Milbank Mem Fund Q Health Soc. 1978 Summer;56(3):339–361. [PubMed] [Google Scholar]
  11. Hobel C. J., Hyvarinen M. A., Okada D. M., Oh W. Prenatal and intrapartum high-risk screening. I. Prediction of the high-rish neonate. Am J Obstet Gynecol. 1973 Sep 1;117(1):1–9. doi: 10.1016/0002-9378(73)90720-5. [DOI] [PubMed] [Google Scholar]
  12. Levy B. S., Wilkinson F. S., Marine W. M. Reducing neonatal mortality rate with nurse-midwives. Am J Obstet Gynecol. 1971 Jan 1;109(1):50–58. doi: 10.1016/0002-9378(71)90833-7. [DOI] [PubMed] [Google Scholar]
  13. Little R. E. Moderate alcohol use during pregnancy and decreased infant birth weight. Am J Public Health. 1977 Dec;67(12):1154–1156. doi: 10.2105/ajph.67.12.1154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McCarthy B. J., Terry J., Rochat R. W., Quave S., Tyler C. W., Jr The underregistration of neonatal deaths: Georgia 1974--77. Am J Public Health. 1980 Sep;70(9):977–982. doi: 10.2105/ajph.70.9.977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Meyer M. B. How does maternal smoking affect birth weight and maternal weight gain? Evidence from the Ontario Perinatal Mortality Study. Am J Obstet Gynecol. 1978 Aug 15;131(8):888–893. doi: 10.1016/s0002-9378(16)33137-4. [DOI] [PubMed] [Google Scholar]
  16. Naeye R. L., Blanc W., Paul C. Effects of maternal nutrition on the human fetus. Pediatrics. 1973 Oct;52(4):494–503. [PubMed] [Google Scholar]
  17. Nesbitt R. E., Jr, Aubry R. H. High-risk obstetrics. II. Value of semiobjective grading system in identifying the vulnerable group. Am J Obstet Gynecol. 1969 Apr 1;103(7):972–985. doi: 10.1016/s0002-9378(16)34448-9. [DOI] [PubMed] [Google Scholar]
  18. Nutting P. A., Barrick J. E., Logue S. C. The impact of a maternal and child health care program on the quality of prenatal care: an analysis by risk group. J Community Health. 1979 Summer;4(4):267–279. doi: 10.1007/BF01319021. [DOI] [PubMed] [Google Scholar]
  19. Patterson J. E. Assessing the quality of vital statistics. Am J Public Health. 1980 Sep;70(9):944–945. doi: 10.2105/ajph.70.9.944. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Peacock P. B., Gelman A. C., Lutins T. A. Annotated bibliography for preventive health care strategies for health maintenance organizations. Prev Med. 1975 Sep;4(3):328–372. doi: 10.1016/0091-7435(75)90068-7. [DOI] [PubMed] [Google Scholar]
  21. Peacock P. B., Gelman A. C., Lutins T. A. Preventive health care strategies for health maintenance organizations. Prev Med. 1975 Jun;4(2):183–225. doi: 10.1016/0091-7435(75)90083-3. [DOI] [PubMed] [Google Scholar]
  22. Reid M. L., Morris J. B. Perinatal care and cost effectiveness: changes in health expenditures and birth outcome following the establishment of a nurse-midwife program. Med Care. 1979 May;17(5):491–500. [PubMed] [Google Scholar]
  23. SHAPIRO S., WEINER L., DENSEN P. M. Comparison of prematurity and perinatal mortality in a general population and in the population of a prepaid group practice, medical care plan. Am J Public Health Nations Health. 1958 Feb;48(2):170–187. doi: 10.2105/ajph.48.2.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. SHWARTZ S., VINYARD J. H., Jr PRENATAL CARE AND PREMATURITY. Public Health Rep. 1965 Mar;80:237–248. [PMC free article] [PubMed] [Google Scholar]
  25. Saward E. W., Greenlick M. R. Health policy and the HMO. Milbank Mem Fund Q. 1972 Apr;50(2):147–176. [PubMed] [Google Scholar]
  26. Shah F. K., Abbey H. Effects of some factors on neonatal and postneonatal mortality. Analysis by a binary variable multiple regression method. Milbank Mem Fund Q. 1971 Jan;49(1):33–57. [PubMed] [Google Scholar]
  27. Terris M., Glasser M. A life table analysis of the relation of prenatal care to prematurity. Am J Public Health. 1974 Sep;64(9):869–875. doi: 10.2105/ajph.64.9.869. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Walker S. H., Duncan D. B. Estimation of the probability of an event as a function of several independent variables. Biometrika. 1967 Jun;54(1):167–179. [PubMed] [Google Scholar]
  29. Wiener G., Milton T. Demographic correlates of low birth weight. Am J Epidemiol. 1970 Mar;91(3):260–272. doi: 10.1093/oxfordjournals.aje.a121135. [DOI] [PubMed] [Google Scholar]
  30. Zackler J., Andelman S. L., Bauer F. The young adolescent as an obstetric risk. Am J Obstet Gynecol. 1969 Feb 1;103(3):305–312. doi: 10.1016/0002-9378(69)90487-6. [DOI] [PubMed] [Google Scholar]

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

RESOURCES