title: Association Between Obesity During Pregnancy and the Adequacy of Prenatal Care.
abstract: OBJECTIVE
  In the United States, more than a third of women are obese [body mass index (BMI) ≥ 30]. Although obese populations utilize health care at increased rates and have higher health care costs than non-obese patients, the adequacy of prenatal care in this population is not well established and assumed to be suboptimal. We therefore evaluated adequacy of prenatal care among obese women.
  
  
  METHODS
  We utilized an electronic database including 7094 deliveries with pre-pregnancy BMI ≥ 18.5 from January 2009 through December 2011. Subjects were categorized as normal weight 18.5-24.9 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2 (class I-II-III). Adequacy of prenatal care (PNC) was evaluated using the Kotelchuck Index (KI), corrected for gestational age at delivery. Adequate care was defined as KI "adequate" or "adequate plus," and non-adequate as "intermediate" or "inadequate." Chi square and logistic regression were used for comparisons.
  
  
  RESULTS
  When compared to non-obese women, obese women were more likely to have adequate PNC (74.1 vs. 68.7%; OR 1.30, 95% CI 1.15-1.47). After adjusting for age, race, education, diabetes, hypertension, and practice type, obesity remained a significant predictor of adequate prenatal care (OR 1.29, 95% CI 1.14-1.46). While age and hypertension were not significant independent predictors of adequate PNC, college education, Caucasian, diabetes, and resident or MFM care had positive associations.
  
  
  CONCLUSIONS
  Maternal obesity is associated with increased adequacy of prenatal care. Although some comorbidities associated with obesity increase utilization of prenatal services, this did not explain the improvement in PNC adequacy associated with obesity.
  
  
  CONCLUSIONS
  Overweight and obese women are at a higher risk of pregnancy complications with obesity contributing to increased morbidity and mortality of the mother. Several studies have evaluated barriers to routine health care services, with obese parturients perceiving their weight to be a barrier to obtaining appropriate care. There is limited data available assessing the adequacy of prenatal care in this population. Our study demonstrated that obesity was actually associated with an increased adequacy of prenatal care. The presence of comorbidities did not explain this improvement in prenatal care.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA. pzsmithmfm@gmail.com.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Zozzaro-Smith
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bacak
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
authors.forename: Ciara
authors.initials: C
authors.lastname: Conway
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Glantz
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
authors.forename: Loralei L
authors.initials: LL
authors.lastname: Thornburg
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D009765:Obesity / Q000453:epidemiology / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care / Q000592:standards*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Adequacy; Kotelchuck; Obesity; Pregnancy; Prenatal care