Figure 9-1, 6 to 7 percent of women in this country have late or no prenatal care. In 2014, the percentages of non-Hispanic white, Hispanic, and African-American women who received inadequate or no prenatal care were 4.3, 7.5, and 9.7, respec tively (Child Trends, 2015).
he Centers for Disease Control and Prevention (CDC) (2000) analyzed birth certificate data and found that half of women with delayed or no prenatal care wanted to begin care earlier. Barriers to care varied by social and ethnic group, age, and payment method. he most common reason cited was late recognition of pregnancy by the patient. The second most commonly cited obstacle was lack of money or insurance. he third was inability to obtain an appointment.
Care designed during the early 1900s focused on lowering the extremely high maternal mortality rate. Prenatal care undoubtedly contributed to the dramatic decline in this mortality rate from 690 deaths per 100,000 births in 1920 to 50 per 100,000 •• Births in all states Births in states using the 1989 birth certificate/revision • Births in states using the 2003 birth certificate/revision
FIGURE 9-1 Percentage of births to mothers who received late or no prenatal care-United States, 1990-2014. (Data from Trends, 2015.) by 1955 (Loudon, 1992). And, the low current maternal mortality rate of 10 to 15 per 100,000 is likely associated with the high utilization of this care (Xu, 2010). Indeed, data from 1998 to 2005 from the Pregnancy \10rtality Surveillance System identified a ivefold increased risk for maternal death in women who received no prenatal care (Berg, 2010).
Other reports also attest to prenatal care eicacy. In a study of almost 29 million births, the risk for preterm birth, stillbirth, early and late neonatal death, and infant death rose linearly with decreasing prenatal care (Partridge, 2012). Similarly, Leveno and associates (2009) found that a significant decline in preterm births at Parkland Hospital correlated closely with increased use of prenatal care by medically indigent women. Moreover, National Center for Health Statistics data showed that women with prenatal care had an overall stillbirth rate of 2.7 per 1000 compared with 14.1 per 1000 for women without this care (Vintzileos, 2002).
Evaluating the format of care, Ickovics and coworkers (2016) compared individual prenatal care and group prenatal care. he latter provided traditional pregnancy surveillance in a group setting with special focus on support, education, and active healthcare participation. Women enrolled in group prenatal care had significantly better pregnancy outcomes. Carter and colleagues (2016) cited similar results. Childbirth education classes are also reported to result in better pregnancy outcomes (Afshar, 2017). Adolescent pregnancies carry special risk, and guidelines have been developed that focus on this subgroup (Fleming, 2015). Few data are available to recommend the practice of ofering tangible incentives to improve prenatal care attendance (Till, 2015).
Pregnancy is usually identified when a woman presents with symptoms and possibly a positive home urine pregnancy test result. Typically, these women receive conirmatory testing of urine or blood for human chorionic gonadotropin (hCG). Further, presumptive signs or diagnostic indings of pregnancy may be found during examination. Sonography is often used, particularly if miscarriage or ectopic pregnancy is a concern.
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