Unplanned pregnancy as a major determinant in inadequate use of prenatal care.

BACKGROUND

Previous reports have stressed the importance of social class and education in prenatal care use. Unplanned pregnancy as a determinant of prenatal care use has been insufficiently studied. The objective of this report was to assess whether unplanned pregnancy is an independent predictor of inadequate use of prenatal care.

METHODS

A 5% sample of women delivering at a hospital (409 women in the study population) was selected. Data on pregnancy were obtained by personal interview and from clinical charts. Prenatal care was considered inadequate according to the Kessner index. Relative risk (RR) and 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was applied to select the independent predictors of inadequate prenatal care use.

RESULTS

Prenatal care use was inadequate among 16.4% of the women. Pregnancy was unplanned among 42.8% of the women. Twenty-two percent of women with an unplanned pregnancy used prenatal care inadequately, while 12% of those with planned pregnancies used prenatal care inadequately (RR = 1.9, 95% CI = 1.2-2.9). In crude analysis, inadequate prenatal care use was also related to lower social class, lower education level, no employment outside the home, and multiparity. After adjustment was made for other predictors that were included in a stepwise logistic regression model (maternal education, social class, maternal occupation, parity, and pregnancy-induced hypertension), unplanned pregnancy was a significant risk factor for inadequate use of prenatal care (odds ratio = 2.1, 95% CI = 1.2-3.7) and it was an independent predictor for a delayed first prenatal care visit and for a reduced number of visits.

CONCLUSIONS

The results suggest that unplanned pregnancy is a major determinant for inadequate use of prenatal care.