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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Lakota K. Kruse, MD, MPH1, Charles E. Denk, Ph D2, and Ingrid Morton Mitchell, MS2. (1) Division of Family Health Services, New Jersey Department of Health and Senior Services, P O Box 364, Trenton, NJ 08625, (609) 292-5656, lkruse@doh.state.nj.us, (2) Maternal and Child Health Epidemiology, New Jersey Department of Health and Senior Services, P.O. Box 364, Trenton, NJ 08625-0364
Objective: Explore patterns of prenatal care (PNC) utilization across longitudinally linked birth certificates. Methodology: Electronic birth certificates in NJ from 1996 to 2001 were probabilistically matched using AUTOMATCH software. Using the Adequacy of Prenatal Care Utilization Index (Kotelchuck), first-to-second-pregnancy transition matrices are examined. An ordinal-logistic model predicts PNC utilization in the second pregnancy conditioned on utilization in the first pregnancy and other predictor variables. Results: Among all births in the cohort, the proportion of mothers falling into each of the PNC categories remained virtually unchanged from first to second pregnancy. However, only 75% of women with adequate or better PNC utilization in the first pregnancy maintained an adequate or better level in the second. About 4% of NJ mothers comprise an “underclass” of persistent PNC under-utilization: while just over one in ten women had inadequate PNC in each pregnancy, 37% of inadequate users in the first pregnancy repeated for the second pregnancy, and another 19% received intermediate PNC—still below “adequate.” According to the ordinal-logistic model, mothers who were unmarried, less than high school education, teen, and non-Hispanic black had lower utilization than others in the second pregnancy. Participation in programs like WIC improves PNC utilization. Implications: Longitudinally linked birth certificate files are a valuable resource to examine behaviors across the reproductive histories of mothers. PNC utilization, whose effects on birth outcomes are well documented, exhibits variation across mothers and between pregnancies. Evaluation of programs that can improve PNC access and utilization from first to later pregnancies should be a high priority.
Learning Objectives: At the conclusion of the session, the participant will
Keywords: Prenatal Care, Reproductive Health Research
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.