Relationship of prenatal care and perinatal morbidity in low-birth-weight infants.
OBJECTIVE
Lack of or no prenatal care (NPC) is associated with preterm birth (PTB) and low birth weight (LBW). Our purpose was to determine whether LBW infants delivered after NPC have worse outcomes than LBW infants with prenatal care (PC).


METHODS
Eight thousand sixty-five consecutive women delivered at six hospitals in Shelby County, Tenn, were evaluated regarding clinical characteristics and perinatal outcomes depending on the occurrence of PC. Infant and LBW infant outcomes were evaluated on the basis of the occurrence of PC. Multivariate analysis was performed for neonatal outcomes adjusting for race, plurality, antenatal steroids, amnionitis, and ponderal index. A P value less than .05 was considered significant.


RESULTS
NPC women were more likely multiparous (80% vs 65%), African American (70% vs 61%), and uninsured (25% vs 4%), P<.0001 for each. PTB (36% vs 15%) and LBW (22% vs 12%) were more common with NPC, P<.0001 for each. Women with NPC had more advanced cervical dilation (ACD) greater than 4 cm (ACD: 63% vs 39%) and more amnionitis on admission (2% vs 1%), P<or=.001 for each, and had more fetal distress in labor, P=.02. NPC infants had increased mortality, respiratory distress syndrome, intraventricular hemorrhage, retinopathy, and bronchopulmonary dysplasia. Among LBW infants, NPC was associated with premature rupture of membranes, antepartum hemorrhage, amnionitis, and ACD. Controlling for other factors, NPC LBW infants had increased mortality (17% vs 9%), respiratory distress syndrome (31% vs 24%), intraventricular hemorrhage (10% vs 5%), retinopathy (13% vs 9%), and bronchopulmonary dysplasia (11% vs 7%), P<or=.04 for each.


CONCLUSIONS
In addition to increasing PTB and LBW, NPC is associated with increased perinatal morbidity and mortality among LBW infants after controlling for confounding factors.
Department of Obstetrics and Gynecology of MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Melissa A
MA
Herbst
Brian M
BM
Mercer
Dorothy
D
Beazley
Norman
N
Meyer
Teresa
T
Carr
D000328:Adult; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology