Effect of chronic illness on barriers to and use of prenatal care among low-income pregnant women

Women who have chronic illness may be more likely than others to either delay entry into prenatal care (PNC) because of increased barriers, or enter early because of already established relationships with the health care delivery system. To examine this relationship, 130 African-American low-income postpartum women in two Chicago communities were asked about their PNC experience and health status before and during pregnancy.

The survey asked about 11 chronic conditions; 61 women (46.9%) reported having been diagnosed with one or more of these conditions prior to pregnancy. The most common were lung problems/asthma (20.8%), migraines (16.9%), and obesity/overweight (10.8%).

Women were also asked about barriers to PNC. The most common were transportation (25.4%) and clinic hours (22.3%). Women with chronic conditions had a mean of 1.87 barriers, whereas women without chronic conditions averaged 1.57 barriers. Women with chronic illness were 2.1 times more likely to have a barrier than women without chronic illness (95% CI, 0.8-5.7). Women diagnosed with chronic conditions before pregnancy were 1.5 times more likely to begin PNC after the first trimester (95% CI, .3-1.4) and 2.1 times more likely to delay PNC until after half way through pregnancy (95% CI, .16-1.4).

Despite higher risk status, low-income women with chronic illness appear more likely to have barriers and delay PNC entry. In order to actualize PNC benefits, efforts to connect women to care as early in pregnancy as possible are essential. Health outreach prior to pregnancy might be the most important strategy.