Timing of enhanced prenatal care and birth outcomes in New Jersey's HealthStart program.
OBJECTIVE
This study examined the effects of prenatal care and the timing of its initiation on birth weight and gestational age outcomes among women in a state-wide Medicaid enhanced prenatal care program.


METHODS
Ordinary Least Squares and logistic regression analyses were performed using data on 88,196 births in New Jersey between 1988 and 1996. A large number of potentially confounding factors were included.


RESULTS
Initiating prenatal care in the first trimester was associated with a 56 g advantage in birth weight (p = .01) compared to no care. Initiating prenatal care in the first or second trimester was associated with a 1 day advantage in gestational age (p = .05). There were no significant effects of prenatal care, initiated in any trimester, on low-birth weight. Initiating care in the first versus the second trimester had no effect on the probability of delivering preterm. The findings did not vary by sociodemographic subgroup.


CONCLUSIONS
This study provides support for claims that there is little that prenatal care can do to improve aggregate birth outcomes because most pregnancy complications are the result of behaviors and life circumstances that precede the pregnancy and are very difficult to reverse. Prenatal care, even with enhanced services, appears to offer too little, too late.
Reichman
Nancy E
NE
Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, NJ 08903, USA. nancy.reichman@umdnj.edu
Teitler
Julien O
JO
D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008484:Medicaid; D009515:New Jersey; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration*; D011787:Quality of Health Care