Issues in determining and measuring adequacy of prenatal care.

Research has demonstrated that adequate prenatal care is an effective intervention that improves pregnancy outcomes, including reducing infant mortality rates. Currently, there are three methods to determine the adequacy of prenatal care, including American College of Obstetricians and Gynecologists Standards, Kessner Index, and Adequacy of Prenatal Care Utilization Index. All three methods have been used to measure prenatal care for women with low-risk pregnancies. Their use in women with a high-risk pregnancy is problematic. Use of a ratio index for women with a high-risk pregnancy is suggested. Following the criteria suggested by the Public Health Expert Panel on the Content of Prenatal Care to assess the effectiveness of prenatal care is recommended. Evaluating both quantity and content of prenatal care visits would more accurately reflect adequacy of prenatal care.