Aileen G. Buckler, MD, MPH, Center for Acute Disease Epidemiology, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th St., Des Moines, IA 50319, (515) 242-3892, agbuckler@yahoo.com, William R. Nelson, MD, MPH, Virginia Department of Health, Chesterfield Health District, (501 Lucy Corr Circle, P.O. Box 100, Chesterfield, VA 23832, and Saba Masho, MD, DrPH, Preventive Medicine and Community Health, Virginia Commonwealth University, 1008 E. Clay Street, Grant House, P. O. Box 980212, Richmond, VA 23298.

Objective: To examine the association between inadequate prenatal care utilization and preterm delivery in Virginia and determine if a relationship exists after adjusting for confounders. Methods: Singleton, first births between 20 and 45 weeks gestation in Virginia from 1998 – 2000 were examined. Adequacy of prenatal care utilization was measured using the Adequacy of Prenatal Care Utilization (APNCU) index. Factors examined for confounding included maternal race, age and education, payment method, tobacco, alcohol and drug use, marital status and pregnancy weight gain. Preterm delivery was defined as delivery occurring at less than 37 completed weeks of pregnancy. Rates of preterm delivery were compared between the four APNCU categories. Adjusted odds ratios with 95% confidence intervals were determined using logistic regression to control for covariates. Results: Of the 119,785 births analyzed, 9.3% were found to be preterm. Those receiving inadequate care were more likely to drink alcohol, smoke, use drugs, be of black race or Hispanic ethnicity, be less educated, have lower pregnancy weight gain, be self-pay, have Medicaid, be at the extremes of age and be unmarried. After adjusting for confounders, those with inadequate and adequate+ care using the APNCU index (inadequate: POR 1.38, 95% CI (1.27, 1.50), adequate+: POR 6.42, 95% CI (6.11, 6.75)) were significantly more likely to deliver prematurely. Conclusion: The results of this study support the hypothesis that inadequate prenatal care utilization is associated with an increased risk of preterm delivery. This relationship persists after adjusting for confounders that are themselves associated with preterm delivery.

Learning Objectives: At the conclusion of this session, participants will be able to

• Identify morbidities and costs associated with preterm delivery.
• Explain the Adequacy of Prenatal Care Utilization Index and how it may be more useful for measuring prenatal care than using number of visits alone.
• List five risk factors that have been linked to preterm delivery.
• Identify the types of follow up studies that need to be done to further explore the relationship between preterm delivery and prenatal care.

Keywords: Prenatal Care, Pregnancy Outcomes

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.