Reduced low birth weight for teenagers receiving prenatal care at a school-based health center: effect of access and comprehensive care.
OBJECTIVE
To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenagers receiving prenatal care in comprehensive adolescent pregnancy programs (CAPPS) in two different settings: school-based vs. hospital-based.


METHODS
Retrospective sohort study using existing data sources: medical records and birth certificates. Using school rosters and hospital clinic databases, we identified pregnant adolescents < or =18 years old who delivered a baby between July 1, 1995 and August 30, 1997 and who received prenatal care in a school-based CAPP (SB-CAPP) or hospital-based CAPP (HB-CAPP). Process of care measures (prenatal care adequacy and comprehensive care) and outcomes (low birth weight) were examined by site of care. Logistic regression models were computed to predict the odds of low birth weight by site of prenatal care, adjusting for prenatal care adequacy, comprehensive care, and possible confounders including baseline maternal characteristics.


RESULTS
Three-hundred-ninety eligible teens were identified. Mean age was 15.9 years, 93% were African-American, 84% in school, 13% had a prior birth, and 11% were cigarette smokers. Teens receiving care in the SB-CAPP were significantly younger and more likely to be in school than those in the HB-CAPP. Overall, the two groups had similar low rates of prenatal care adequacy, but compared with teens in the SB-CAPP, those in the HB-CAPP were 1.5 times less likely to receive comprehensive care. Logistic regression analyses adjusting for baseline maternal differences showed that HB-CAPP teens were more than three times as likely to deliver a low birth weight infant compared with SB-CAPP teens (AOR 3.75; 95% CI 1.05-13.36). The increased odds of low birth weight for HB-CAPP teens attenuated when prenatal care was adequate and comprehensive (AOR-HB-CAPP: 2.31, 95% CI 0.65-8.24).


CONCLUSIONS
School-based prenatal care was associated with significantly lower odds of low birth weight compared with HB-CAPP care. Although selection bias may be a factor in this observational study, our findings suggest that these improved birth outcomes may be mediated through prenatal care adequacy and provision of comprehensive care.
Department of Family Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. bbarnet@som.umaryland.edu
Beth
B
Barnet
Anne K
AK
Duggan
Margo
M
Devoe
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D015142:Baltimore / Q000453:epidemiology; D015331:Cohort Studies; D003191:Comprehensive Health Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D010044:Outpatient Clinics, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011253:Pregnancy in Adolescence; D011295:Prenatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D018570:Risk Assessment; D012572:School Health Services / Q000592:standards* / Q000706:statistics & numerical data