Factors associated with not receiving prenatal care and its impact on birth outcomes

Background: Prenatal care (PNC) has the potential to prevent perinatal morbidity and mortality. Women who receive PNC according to the accepted standards are more likely to have better birth outcomes. Methods: We conducted a population-based, retrospective cohort study on infants born alive to Florida-resident women from 1998-2009 (N=2,328,630) using a linked dataset. Adequacy of PNC was computed using the R-GINDEX algorithm. Logistic regression was used to assess the association between level of PNC and each selected adverse birth outcome. Results: Over 42% of women were characterized as having either intermediate, inadequate, or no care, whereas 45% and 6% had adequate and intensive PNC, respectively. Women who were not married, less educated, young (<20 years), black non-Hispanic, multiparous, and users of alcohol, tobacco, and/or drugs were less likely to receive adequate PNC. When compared to women with adequate PNC, women without any PNC were more likely to give birth to a low birth weight (AOR: 2.24, 95% CI: 2.16-2.31), preterm (AOR: 2.29, CI: 2.23-2.36), or small-for-gestational age (AOR: 1.64, CI: 1.58-1.70) infant. Infants born to mothers who did not receive any PNC had significantly higher median inpatient hospitalization charges at birth than those born to mothers receiving adequate PNC ($2,580 vs. $1,862; p<0.01). Conclusions: Lack of adequate PNC is associated with adverse birth outcomes and higher inpatient hospitalization costs. To reduce the likelihood of adverse pregnancy outcomes, health care professionals should be diligent in educating women who are at risk of not receiving adequate PNC.