Family dysfunction and Native American women who do not seek prenatal care.

OBJECTIVE

To test the hypotheses that, in a health system with few external barriers to care, women with no prenatal care (NPC) have higher rates of nuclear family dysfunction and disproportionate amounts of adverse neonatal outcomes compared with women with prenatal care.

DESIGN

Case-control study.

SETTING

Indian Health Service system.

PATIENTS

Nuclear families of women not seeking prenatal care compared with those who did seek prenatal care.

MAIN OUTCOME MEASURES

Dysfunctional outcome measures in nuclear families were children adopted, placed, or under protective surveillance; mothers denying pregnancy, being abused, or attempting suicide; and parents with alcoholism. Neonatal outcome measures were low birth weight and neonatal intensive care days.

RESULTS

Dysfunctional markers occurred significantly more frequently in families of women with NPC than in families of women with prenatal care (57% of NPC and 12% of control families; McNemar odds ratio, 14; 95% confidence interval, 4.7-41.6). Neonatal outcome in this Native American population showed that women with NPC had only 2.6% (58/2222) of the total births but accounted for 11% of the low-birth-weight infants (< 2500 g), 18% of the very-low-birth-weight infants (< 1500 g), and 24% of the level II and 41% of the level III newborn intensive care days.

CONCLUSIONS

Women not seeking prenatal care in a system with few external barriers to care have significantly more family dysfunction (P < .001) than women seeking prenatal care. Infants of women with NPC generated a disproportionate amount of adverse neonatal outcome. The combination of NPC and family dysfunction was more predictive of adverse neonatal outcome than was NPC alone.