Does maternal residence affect adequacy of prenatal care utilization?

Background: Prenatal care is a central element among efforts to prevent preterm delivery, low birth weight, and infant mortality. The current study examines whether women living in areas with low prenatal care utilization are at increased risk of having inadequate prenatal care, and if that risk is due to the place of residence or to other socio-demographic, structural, or personal factors. Methods: A population-based case-control study was conducted using birth and fetal death certificate data from residents of St. Louis, Missouri during January 1, 2001-December 31, 2002. Cases were defined as all women in the study population who received less than adequate levels of prenatal care utilization based on the APNCU index. Controls included all women from the same study population who received adequate or intensive levels of prenatal care.  Logistic regression analysis was used to adjust the odds ratios for potential confounding bias and to determine if other factors affected the association between maternal residence and inadequate prenatal care utilization. Results: Cases were more likely to reside in areas with less adequate prenatal care utilization than controls. Adjusted odds ratios increased as the percentage of residents achieving adequate or better prenatal care utilization decreased. Conclusions: The presence of an inverse relationship between maternal residence and the risk of inadequate prenatal care utilization suggests that maternal residence might be an important factor affecting a mother's level of prenatal care utilization.