As described by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2012), “A comprehensive antepartum program involves a coordinated approach to medical care, continuous risk assessment, and psychological support that optimally begins before conception and extends throughout the postpartum period and interconceptional period.” Optimizing the health and well-being of women before pregnancy should logically be an integral prelude to prenatal care. Adequate and appropriate preconceptional care, as discussed in detail in Chapter 8, has the potential to assist women by reducing risks, promoting healthy lifestyles, and improving readiness for pregnancy.
Prenatal Care in the United States
Almost a century after its introduction, prenatal care has become one of the most frequently used health services in the United States. In 2001, there were approximately 50 million prenatal visits. The median was 12.3 visits per pregnancy, and many women had 17 or more total visits. This information is gathered from birth certificates, and a revised form was introduced in 2003. It is now used by 27 states and Puerto Rico, whereas the remaining 23 states continue to use a 1989 form. Unfortunately, data regarding the timing of prenatal care from these two systems are not directly comparable (Osterman, 2011).
Since the early 1990s, the largest gains in timely prenatal care have been among minority groups. As shown in Figure 9-1, however, disparity continues. Of the 27 states using the revised birth certificate, the percentage of non-Hispanic white, Hispanic, and African-American women who received no prenatal care in 2008 was 1.1, 2.7, and 3.3, respectively (Osterman, 2011). Some of the obstetrical and medical risk factors or complications identifiable during prenatal care are summarized in Table 9-1. Importantly, many of these complications are treatable.
Percentage of women in the United States with prenatal care beginning in the first trimester by ethnicity in 1989, 2001, and 2006. (Adapted from Martin, 2002b, 2009.)
TABLE 9-1Obstetrical and Medical Risk Factors Detected During Prenatal Care in the United States in 2001 |Favorite Table|Download (.pdf) TABLE 9-1 Obstetrical and Medical Risk Factors Detected During Prenatal Care in the United States in 2001
| ||Births ||Percent |
|Total live births ||4,025,933 ||100 |
|Risk Factor || || |
|Gestational hypertension ||150,329 ||3.7 |
|Diabetes ||124,242 ||3.1 |
|Anemia ||99,558 ||2.5 |
|Hydramnios/oligohydramnios ||54,694 ||1.4 |
|Lung disease ||48,246 ||1.2 |
|Others ||139,860 ||< 1 each |
|Total ||616,929 ||15.3 |
Assessing Prenatal Care Adequacy
A commonly employed system for measuring prenatal care adequacy is the index of Kessner and colleagues (1973). This Kessner Index incorporates three items from the birth certificate: length of gestation, timing of the first prenatal visit, and number of visits. Although it does not measure the ...