title: Disposition and health outcomes among infants born to mothers with no prenatal care.
abstract: OBJECTIVE
  This study assessed infant disposition and health outcomes among offspring born to mothers without prenatal care, based on maternal characteristics and the reason for lack of prenatal care (i.e., denial of pregnancy, concealment of pregnancy, primary substance use, financial barriers and multiparity).
  
  
  METHODS
  A retrospective record review was completed at an urban academic medical center. Subjects were women who presented at delivery or immediately postpartum with no history of prenatal care (N=211), and their infants.
  
  
  RESULTS
  Infants of mothers with substance use problems had the highest rates of referral to child protective services and out-of-home placement at discharge, though mothers with other reasons for no prenatal care also experienced both referral and placement. Infants born to mothers using substances experienced the highest rates of neonatal intensive care unit admission, and the lowest mean birth weight.
  
  
  CONCLUSIONS
  Though those without prenatal care experienced a variety of adverse outcomes, substance use problems were most frequently correlated with adverse infant outcomes. Mothers who either had lost custody of other children or with substance use problems were at highest risk of losing custody of their infants. Those who denied or concealed their pregnancy still frequently retained custody.
  
  
  CONCLUSIONS
  Among mothers without prenatal care, those with substance use problems were least likely to retain custody of their infant at hospital discharge. Custody status of the mother's other children was also independently associated with infant custody. Mothers who denied or concealed their pregnancy still often retained custody. Referrals of mothers with no prenatal care for psychiatric evaluation were rare, though referrals to social work were frequent. Child protective services occasionally did not investigate referrals in the denial and concealment groups. Healthcare providers should be aware of the medical and psychological needs of this vulnerable population of infants and mothers.
authors.forename: Susan Hatters
authors.initials: SH
authors.lastname: Friedman
authors.forename: Amy
authors.initials: A
authors.lastname: Heneghan
authors.forename: Miriam
authors.initials: M
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit; D008875:Middle Aged; D009820:Ohio; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019966:Substance-Related Disorders; D016312:Treatment Refusal; D055815:Young Adult