The Content of Prenatal Care and Its Relationship to Preterm Birth in Alberta, Canada

Abstract

Prenatal care is universally acknowledged as the hallmark of preventive care for pregnant women, and it is commonly assumed to have a positive influence on birth outcomes. The results of studies that have examined the impact of prenatal care on adverse birth outcomes, however, have been equivocal. These investigations have focused primarily on initiation of prenatal care and its timing, and not on the content of care received. Using data obtained from maternal self-reports and an electronic perinatal database, we examined the relationship between selected components of prenatal care (i.e., medical management, health education, and health advice) and the birth of a preterm infant. We found that health care providers are meeting the clinical guidelines for the medical management of pregnancy, but they are not adequately meeting pregnant women's needs for health education and advice. We found no association between the content of prenatal care and the birth of a preterm infant. Prenatal care must focus more on providing health education and advice to pregnant women.

We gratefully acknowledge the financial support received from both the Alberta Heritage Foundation for Medical Research (AHFMR) and the Hole Family Health Promotion Fund, University of Alberta, Edmonton, Alberta, Canada. This project would not have been possible without the technical assistance of the Perinatal Research Centre and the Population Health Research Laboratory. We also acknowledge the support of Dr. Nan Schuurmans (Regional Clinical Program Director, Women's Health, Capital Health) for her helpful comments and suggestions. Dr. Christine Newburn-Cook was the principal investigator of this study.

Notes

∗A history of one or more adverse outcomes in a previous pregnancy (i.e., low birth weight, preterm birth, small for gestational age birth, stillbirth, neonatal death).

∗∗One or more of pregnancy complications (i.e., pregnancy induced hypertension, gestational diabetes, gestational bleeding, premature rupture of membranes).

∗Odds ratio (OR)—Provides an estimate of the relative risk in a case-control study. It is defined as the probability (odds or likelihood) of preterm birth when women do not receive the recommended prenatal advice from their health care provider. If an OR is > 1.0 and the 95% CI does not include 1.0, we can conclude that not receiving health care advice increased the likelihood of delivering preterm.

∗Health behavior advice: included breastfeeding, taking vitamins and minerals, healthy diet, risks of smoking, alcohol and drugs, and appropriate weight gain. This was based on Kogan et al.'s work (1994).

∗∗Procedures: included blood pressure recorded, urine tests, blood analyses, weight recorded, health history, pelvic examination. This was based on Kogan et al.'s work (1994).

∗Estimate of the independent effect of prenatal care content (receiving all recommended advice and medical procedures) on the risk of preterm birth controlling for race, mother's age, marital status, education, income, employment during pregnancy, smoking status, parity, and previous adverse outcome(s) (includes low birth weight, preterm birth, small for gestational age birth, stillbirth and neonatal death, and pregnancy induced hypertension).