title: Relationship between adequacy of prenatal care utilization index and pregnancy outcomes.
abstract: BACKGROUND
  Prenatal care is a comprehensive antepartum care program involving a coordinated approach to medical care and psychosocial support that is optimally offered before conception. Inadequate care during pregnancy can lead to undesirable outcomes, including preterm labor and low birth weight. One of these new, accurate, and comprehensive indicator measurements is adequacy of prenatal care utilization index. This study aimed to assess the adequacy of care and its relationship with preterm labor and low birth weight.
  
  
  METHODS
  This analytic historical cohort study was performed on 420 mothers who referred to health centers in Sari during 2010. Data were collected by interviews and questionnaires. Based on the adequacy of prenatal care utilization, this care was classified into four groups: intensive, adequate, intermediate, and inadequate. Data were analyzed using chi-square test, analysis of variance (ANOVA), Spearman correlation coefficient, and relative risk (RR).
  
  
  RESULTS
  Of the 420 mothers who were studied, inadequate care was observed in 151 (36%) cases, which was the highest percentage of care. There was a significant relationship between the adequacy of prenatal care utilization and preterm labor and low birth weight (for both P < 0.05). Performing inadequate care, the rate of preterm labor was RR = 1.36 times and the rate of low birth weight was RR = 1.08 times more than in adequate and intensive care.
  
  
  CONCLUSIONS
  According to the programs that reduced the number of referrals of pregnant mothers (standardization protocol for mothers in Iran), this study confirms the efficacy of adequacy of prenatal care on reducing preterm labor and low birth weight. This study emphasizes on minimum care performance and the importance of conducting further studies to assess the relationship between quantities of care and other outcomes.
authors.affiliation: Department of Midwifery, faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Tayebi
authors.affiliation: Department of Midwifery, faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shahnaz Turk
authors.initials: ST
authors.lastname: Zahrani
authors.affiliation: Department of Biostatistics, faculty of Public Health, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Rezaali
authors.initials: R
authors.lastname: Mohammadpour
keywords: Adequacy of prenatal care utilization index; Iran; low birth weight; pregnancy outcome; prenatal care; preterm birth