title: Retrospective review of prenatal care and perinatal outcomes in a group of uninsured pregnant women.
abstract: OBJECTIVE
  To assess the adequacy of prenatal care and perinatal outcomes for uninsured pregnant women at two primary care centres in Canada.
  
  
  METHODS
  We conducted a retrospective case comparison study of uninsured women presenting for prenatal care between 2004 and 2007 (n = 71). Control subjects (n = 72) were chosen from provincially insured women presenting for prenatal care during the same period. A modified Kotelchuck Index was used to assess adequacy of care. Frequency of routine prenatal testing (blood tests, ultrasound, cervical swabs, Pap testing, and genetic screening) was compared. Perinatal outcomes assessed included gestational age and birth weight.
  
  
  RESULTS
  Uninsured pregnant women presented for initial care 13.6 weeks later than insured women (at 25.6 weeks vs. 12.0 weeks, P < 0.001). Uninsured women had fewer blood tests (93.7% vs. 100%, P = 0.045), ultrasound screenings (82.5% vs. 98.4%, P = 0.003), cervical swabs (69.8% vs. 85.2%, P = 0.04), Pap tests (38.1% vs. 75.4%, P < 0.001), genetic screenings (12.7% vs. 44.3%, P < 0.001), and visits with health care providers (6.6 vs. 10.7, P = 0.05). Using a modified Kotelchuck Adequacy of Prenatal Care Utilization Index, uninsured women were more likely to be categorized as receiving "inadequate care" (uninsured 61.9% vs. insured 11.7%, P < 0.001).
  
  
  CONCLUSIONS
  This study begins to document the care of uninsured pregnant women in Canada. Women in this category presented late for prenatal care, were less likely to have adequate screening tests, and were more likely to receive "inadequate care" as defined by the modified Kotelchuck Index. This information may be valuable in helping to plan programs to improve access to timely and adequate medical care for uninsured pregnant women.
authors: Herzl Family Practice Centre, Jewish General Hospital, Montreal, QC.
authors: Catherine
authors: C
authors: Jarvis
authors: Marie
authors: M
authors: Munoz
authors: Lisa
authors: L
authors: Graves
authors: Randolph
authors: R
authors: Stephenson
authors: Vinita
authors: V
authors: D'Souza
authors: Vania
authors: V
authors: Jimenez
mesh_terms: D000328:Adult; D001724:Birth Weight; D002170:Canada; D005260:Female; D005865:Gestational Age; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D017057:Medically Uninsured; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult