Lima Dos Santos Sueny P, Calloway Eric E, Chertok Ilana R A, Haile Zelalem T
Graduate College, Ohio University College of Health Sciences and Professions, Athens, Ohio.
Center For Nutrition and Health Impact, Omaha, Nebraska.
J Midwifery Womens Health. 2024 Nov-Dec;69(6):917-928. doi: 10.1111/jmwh.13707. Epub 2024 Nov 26.
Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion.
This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices.
The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups.
The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.
早产和小于胎龄儿（SGA）是美国重大的公共卫生问题，不同种族和族裔群体之间存在显著差异。传统的产前护理充足性指标在全面反映其多方面性质方面存在局限性。我们的研究引入了综合产前护理指数（CPCI），通过整合产前咨询和健康促进的关键要素，对产前护理进行更全面的评估。
这项横断面研究使用了2016 - 2021年妊娠风险评估监测系统的数据。CPCI是在全面文献综述的基础上开发的，纳入了产前检查的时间、频率和内容等要素。该指数使用项目反应理论（IRT）进行验证，并与科特尔查克指数和凯斯纳指数进行比较。
该研究纳入了139,181名孕妇。CPCI表现出很强的内部一致性（克朗巴哈α系数为0.75；总体ω系数为0.81）。IRT分析证实该指数能够捕捉产前护理质量的变异性，项目难度参数范围为 - 2.93至 + 2.10。CPCI得分与不良出生结局几率的降低显著相关。充足的CPCI护理与非西班牙裔白人女性早产几率降低63%相关，西班牙裔女性（优势比[OR]，0.59）和亚裔女性（OR，0.38）也有类似程度的降低。对于小于胎龄儿，充足的护理对非西班牙裔白人（OR，0.86）和西班牙裔女性（OR，0.82）有保护作用，但在其他群体中结果不一。
与传统指数相比，CPCI为产前护理质量提供了更具包容性的衡量标准。该研究结果表明，全面的产前护理在减少不良出生结局和解决种族和族裔差异方面发挥着重要作用。未来的研究应专注于完善CPCI，并探索其在不同人群中的适用性，以为有针对性的、具有文化敏感性的产前护理策略提供依据。
