The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions.
OBJECTIVE
The purpose of this study was to determine the association between prenatal care in the United States and the neonatal death rate in the presence and absence of antenatal high-risk conditions.


METHODS
Data were derived from the national perinatal mortality data sets for the years 1995 through 1997, which were provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation. Multivariable logistic regression analyses were used to adjust for the presence or absence of various antenatal high-risk conditions, maternal age, gestational age at delivery, and birth weight.


RESULTS
Of 10,530,608 singleton live births, 18,339 (1.7/1000 births) resulted in neonatal death. Neonatal death rates (per 1000 live births) were higher for African American infants compared with white infants in the presence (2.7 vs 1.5, respectively) and absence (10.7 vs 7.9, respectively) of prenatal care. Lack of prenatal care was associated with an increase in neonatal deaths, which was greater for infants born at > or =36 weeks of gestation (relative risk, 2.1; 95% CI, 1.8, 2.4). Lack of prenatal care was also associated with increased neonatal death rates in the presence of preterm premature rupture of the membranes (relative risk, 1.3; 95% CI, 1.1, 1.5), placenta previa (relative risk, 1.9; 95% CI, 1.2, 2.9), fetal growth restriction (relative risk, 1.7; 95% CI, 1.2, 1.6), and postterm pregnancy (relative risk, 1.4; 95% CI, 1.0, 2.9).


CONCLUSIONS
In the United States, prenatal care is associated with fewer neonatal deaths in black and white infants. This beneficial effect was more pronounced for births that occurred at > or =36 weeks of gestation and in the presence of preterm premature rupture of the membranes, placenta previa, fetal growth restriction, and postterm pregnancy.
Vintzileos
Anthony M
AM
Division of Maternal-Fetal Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, USA.
Ananth
Cande V
CV
Smulian
John C
JC
Scorza
William E
WE
Knuppel
Robert A
RA
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D005317:Fetal Growth Retardation / Q000401:mortality; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D010923:Placenta Previa / Q000401:mortality; D011247:Pregnancy; D011273:Pregnancy, Prolonged; D011295:Prenatal Care; D012307:Risk Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data