Effect of prenatal care on obstetrical outcome.

The purpose of this study was to examine the demographic and obstetrical outcomes of women with poor prenatal care. A 7-year (1987-1993) computerized perinatal database with 29,225 consecutive deliveries was collected prospectively from a single inner city tertiary medical center. Data from 23,181 women who had documented prenatal visits during their pregnancies were used in the analysis. Overall, 21,004 (90.6%) of the mothers had at least 3 prenatal visits (C), while 2,177 (9.4%) had 2 or fewer visits (NC). The proportion of NC did not change significantly over the years (P = 0.47, by trend test). The NC group was 2.3 times more likely to be unmarried (79.8% vs. 59.4%; P < 0.001), have greater parity (mean +/- SD 2.1 +/- 1.9 vs. 1.2 +/- 1.2; P < 0.001), 6.3 times more likely to be staff patients (have no private insurance), and 1.5 times more likely to be black. The average maternal age was 24 years for both groups (P = 0.65). NC mothers delivered at an earlier gestational age (37.3 +/- 3.3 vs. 39.0 +/- 2.6 weeks; P < 0.001), had lower birth weights (BW) (2,810 +/- 743 vs. 3,203 +/- 607 g for singleton births; P < 0.001), and their infants had longer neonatal hospital stays (8.4 +/- 17.3 vs. 4.8 +/- 10.4 days; P < 0.001) compared with C mothers. Moreover, after adjusting for various confounding factors known to effect BW, C mothers delivered infants which were on the average 550 g heavier than the NC mothers. The neonates of NC had consistently lower Apgar scores and were more likely be delivered in breech presentation (5.7% vs. 3.1%) and to be transferred to the neonatal intensive care unit (11.6% vs. 5.2%; P < 0.001). However, the NC group had fewer cesarean deliveries (9.4% vs. 14.2%; P < 0.001) but more thick meconium fluid (12.4% vs. 8.9%; P < 0.001). In conclusion, the women not seeking adequate prenatal care are more likely to be unmarried, black, and staff patients having several children at home. NC mothers tend to have poor obstetrical outcomes and on the average their neonatal stay in the hospital is twice as long as women obtaining adequate prenatal care.