title: Association between prenatal care and small for gestational age birth: an ecological study in Quebec, Canada.
abstract: BACKGROUND
  In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight < 10th percentile on the Canadian scale).
  
  
  METHODS
  In this ecological study, births were identified from Quebec's registry of demographic events between 2006 and 2008 (n = 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs) were adjusted for mother's age, marital status, parity, program coverage and mean income in the area.
  
  
  RESULTS
  Mothers eligible for the programs remain at a higher odds of SGA than non-eligible mothers (OR = 1.40; 95% confidence interval [CI]: 1.30-1.51). Further, areas that provide more visits to eligible mothers (4-6 food supplementation visits) seem more successful at reducing the frequency of SGA birth than those that provide 1-2 or 3 visits (OR = 0.86; 95% CI: 0.75-0.99).
  
  
  CONCLUSIONS
  Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done.
authors.affiliation: Ministère de la Santé et des Services sociaux du Québec, Québec, Quebec, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Savard
authors.affiliation: Département de médecine sociale et préventive, Université Laval, Québec, Quebec, Canada.|Santé environnementale et toxicologie, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Levallois
authors.affiliation: Département de mathématique et statistiques, Université Laval, Québec, Quebec, Canada.
authors.forename: L P
authors.initials: LP
authors.lastname: Rivest
authors.affiliation: Vice-présidence aux affaires scientifiques, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Gingras
mesh_terms: D003710:Demography; D005260:Female; D005865:Gestational Age; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006306:Health Surveys; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D020380:Needs Assessment; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
keywords: birth weight; gestational age; health behaviour; intervention; reproductive health