Words: prenatal care and low birth weight Women Health. 2005;41(3):1 2!.

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Potentially Avoidable Maternity ComplicationsAn Indicator of Access to Prenatal and Primary Care During Pregnancy.
Laditka SB" Laditka !" Mastanduno MP" Lauria M"" #oster $C. " #rnold $chool o% &'blic Health" Health $ciences (ldg" 11!)" *00 $'mter $treet" +ol'mbia" $+" 2,20*" sladit-a.gwm.sc.ed'. /b0ecti1e: We identi%ied &otentiall2 #1oidable 3aternit2 +omplications (&#3+s). 4sed with hospital discharge data" &#3+s ma2 indicate lac- o% prenatal care access. 3ethods: # research team o% two obstetrician5g2necologists and three health ser1ices researchers de1eloped the &#3+ indicator" which was 1eri%ied b2 e6ternal re1iew. #73 1 'sed the 8ational 3aternal and 7n%ant Health $'r1e2" with prenatal care in%ormation and *"!!1 pregnanc2 hospitali9ations" to e6amine associations between prenatal care" ris- %actors" and &#3+s. #73 2 'sed the 1,,: 8ationwide 7npatient $ample (87$)" with *,5"25, pregnanc2 related hospitali9ations" to e6amine &#3+ ris-s %or gro'ps li-el2 to ha1e prenatal care access problems. ;es'lts: 7n #73 1" ade<'ate prenatal care red'ced &#3+ ris-s b2 5:= (p > .01). +ompared to nonsmo-ers" the odds o% a &#3+ %or smo-ers were *!= higher (p > .01). +ocaine 'se increased &#3+ ris- notabl2 (odds ratio 3.35" p > .0001). 7n the m'lti1ariate anal2ses o% #73 2" #%rican #mericans" the 'nins'red" and 3edicaid bene%iciaries had high &#3+ ris-s (all p > .0001). +oncl'sions: )indings s'ggest ade<'ate prenatal care ma2 red'ce &#3+ ris-s. ;es'lts %or gro'ps with less prenatal care access were consistent with pre1io's research 'sing less re%ined indicators" s'ch as low birth weight. &#3+s impro1e on earlier meas'res" and readil2 permit ad0'stments %or mothers? ages and comorbidities. &37@: 15,:05:3 A&'b3ed in processB

2: Cropical doctor Crop @oct. 2005 #pr;35(2):103 4.

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#re%uency of prenatal care visits by et&nic minority mot&ers and association 'it& infant birt&'eig&t in Bac (an Province) *ietnam.
+ien !$" ,s&i-ima +. @epartment o% @e1elopmental 3edical $ciences" $chool o% 7nternational Health" Drad'ate $chool o% 3edicine" Che 4ni1ersit2 o% Co-2o" : 3 1 Hongo" ('n-2o -'" Co-2o 113 0033" Eapan. Che ob0ecti1e o% this cross sectional st'd2 was to e1al'ate the association between prenatal care 1isits and in%ant birthweight among ethnic minorit2 mothers in the mo'ntaino's (ac Fan pro1ince.Chis was done b2 comparing the %re<'enc2 and timing o% %irst prenatal care 1isit o% 32 mothers with low birthweight (G(W) in%ants and 32 mothers with normal birthweight (8(W) in%ants. @'ring pregnanc2" mothers o% 8(W in%ants 'nderwent 3.4H5 1 (mean) prenatal care 1isits and mothers o% G(W in%ants 2.*H5 0., (& I 0.02). 3others o% 8(W in%ants 'nderwent their %irst prenatal care 1isit at 13.1H5 5.: wee-s o% gestation" one wee- earlier than mothers o% G(W in%ants. Che %re<'enc2 o% prenatal care 1isit are probabl2 associated with a decreased ris- o% G(W among ethnic minorit2 mothers in (ac Fan pro1ince. &37@: 15,:003: A&'b3ed inde6ed %or 3J@G78JB

2* 3aternal and +hild Health Eo'rnal 3atern +hild Health E. 2005 E'n;,(2):151 *.

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$iming of en&anced prenatal care and birt& outcomes in !e' ersey.s +ealt&Start program.
"eic&man !/" $eitler 0. @epartment o% &ediatrics" ;obert Wood Eohnson 3edical $chool" 4ni1ersit2 o% 3edicine and @entistr2 o% 8ew Eerse2" 8E 0*,03" 4$#. nanc2.reichman.'mdn0.ed' /(EJ+C7KJ: Chis st'd2 e6amined the e%%ects o% prenatal care and the timing o% its initiation on birth weight and gestational age o'tcomes among women in a state wide 3edicaid enhanced prenatal care program. 3JCH/@$: /rdinar2 Geast $<'ares and logistic regression anal2ses were per%ormed 'sing data on **"1,! births in 8ew Eerse2 between 1,** and 1,,!. # large n'mber o% potentiall2 con%o'nding %actors were incl'ded. ;J$4GC$: 7nitiating prenatal care in the %irst trimester was associated with a 5! g ad1antage in birth weight (p I .01) compared to no care. 7nitiating prenatal care in the %irst or second trimester was associated with a 1 da2 ad1antage in gestational age (p I .05). Chere were no signi%icant e%%ects o% prenatal care" initiated in an2 trimester" on low birth weight. 7nitiating care in the %irst 1ers's the second trimester had no e%%ect on the probabilit2 o% deli1ering preterm. Che %indings did not 1ar2 b2 sociodemographic s'bgro'p. +/8+G4$7/8: Chis st'd2 pro1ides s'pport %or claims that there is little that prenatal care can do to impro1e aggregate birth o'tcomes beca'se most pregnanc2 complications are the res'lt o% beha1iors and li%e circ'mstances that precede the pregnanc2 and are 1er2 di%%ic'lt to re1erse. &renatal care" e1en with enhanced ser1ices" appears to o%%er too little" too late. &37@: 15,!5!20 A&'b3ed inde6ed %or 3J@G78JB

41 Health +are %or Women 7nternational Health +are Women 7nt. 2005 3ar;2!(3):2!2 *0.
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Assessment of risk factors for lo' birt& 'eig&t deliveries.

Lasker !" Coyle B" Li (" 0rtynsky M. @epartment o% $ociolog2 and #nthropolog2" Gehigh 4ni1ersit2" (ethlehem" &enns2l1ania 1*015" 4$#. 0'dith.las-er.lehigh.ed' ;ecognition o% a higher than a1erage incidence o% low birth weight (G(W) deli1eries in areas o% Jastern &enns2l1ania led to an anal2sis o% more than 5"500 deli1eries in one o% the region?s hospital s2stems to in1estigate the predictors o% G(W in that pop'lation. ;es'lts o% m'lti1ariate anal2sis indicate -e2 1ariables that contrib'te to G(W: in partic'lar" racial5ethnic bac-gro'nd and speci%ic medial problems d'ring pregnanc2" incl'ding preeclampsia" incompetent cer1i6" bleeding" low (37 and lac- o% ade<'ate weight gain. ;es'lts were incorporated into training in best practices %or prenatal care in the cit2?s prenatal clinics. &37@: 15*04!,: A&'b3ed inde6ed %or 3J@G78JB

43 Che 0o'rnal o% obstetrics and g2naecolog2 research E /bstet D2naecol ;es. 2005 #pr;31(2):133 ,.

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Antenatal care in t&e capital city of Cambodia1 current situation and impact on obstetric outcome.
#u-ita !" Matsui M" Srey S" Po CS" ,ong S" (oum (. ('rea' o% 7nternational +ooperation" 7nternational 3edical +enter o% Eapan" Co-2o" Eapan. nori-o%.t-m.att.ne.0p #73$: Co anal29e the sit'ation o% antenatal care (#8+) attendance in the capital o% +ambodia" &hnom &enh" and the e%%ect o% #8+ attendance on deli1er2 and newborn o'tcome" in order to establish a strateg2 %or #8+ in the national reprod'cti1e health program in +ambodia. 3JCH/@$: Chis was a health %acilit2 based retrospecti1e cohort st'd2. (ac-gro'nd %actors (ed'cation" ho'sehold income" and parit2) were obtained thro'gh inter1iew" and obstetric in%ormation (cesarean section" low birth weight" and maternal complications) were collected %rom the medical records o% women who deli1ered d'ring 1 month at all the p'blic and pri1ate health %acilities in &hnom &enh. ;elations were anal29ed between the n'mber o% #8+ 1isits" bac-gro'nd %actors" and obstetric o'tcome. ;J$4GC$: # total o% 1204 responses were recei1ed %rom &hnom &enh residents" representing *4= o% the estimated n'mber o% deli1eries in the cit2. /% these" *,= were %rom p'blic health %acilities. Gow ed'cational le1el" low ho'sehold income" and m'ltiparit2 were ris- %actors %or #8+ attendance. Chere was no association between the n'mber o% #8+ attendances and obstetric o'tcome. +/8+G4$7/8$: /'r st'd2 has shown that &hnom &enh residents ha1e good access to #8+ and deli1er2 care. Gow socioeconomic %actors are ris- %actors to #8+. Che n'mber o% #8+ 1isits had no association with poor perinatal o'tcome" b't %'rther st'd2 on <'alit2 o% #8+ and its impact on obstetric o'tcome is needed. Within the limited reso'rces" sa%e motherhood strategies need to be targeted to the r'ral area and to the poor in order to increase access to #8+ and deli1er2 care. &37@: 15::1!3, A&'b3ed inde6ed %or 3J@G78JB

52 &r9eglad epidemiologic9n2 &r9egl Jpidemiol. 2004;5*(3):53: 4!.

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2,se of prenatal &ealt& care and risk of infants born small3for3 gestational3age. Preliminary results of a case3control study in t&e Lod4 voivodes&ip5
A#rticle in &olishB Ciesla B" +anke 6" 7rod4icka A" 7ulc4ynska /" Pa'lo'ska B" 6asile'ska36ilk /. Wo0ewod9-ie +entr'm Ldrowia &'blic9nego w God9i. nad9or.wc9p lod9.pl 7t is well doc'mented that small %or gestational age ($D#) in%ants are at an increased ris- o% perinatal mortalit2 and morbidit2. 7n order to identi%2 the ma0or modi%iable ris- %actors o% $D# birth" a case control st'd2 was la'nched in the area o% God9 1oi1odeship" &oland. Che pro0ect was %oc'sed on the e1al'ation o% the role o% perinatal health ser1ices and a1oidance o% e6pos're to tobacco smo-e in the pre1ention o% $D# births. Che st'd2 pop'lation consisted o% mothers o% 153 $D# in%ants (cases) and ,3 mothers o% control in%ants. $D# in%ants were identi%ied as in%ants with bod2 weight below 10th percentile %or gestational age" 'sing (allarda scale. Che controls were non $D# in%ants deli1ered a%ter 3: wee- o% gestation. Che in%ants %rom both gro'ps were deli1ered in 2! maternit2 wards in the God9 1oi1odeship within the period o% E'ne 1 8o1ember 1" 2003. /ne month a%ter deli1er2" each mother o% $D# and control in%ants was 1isited b2 an inter1iewer who collected in%ormation abo't her pro%ile o% 'se o% perinatal health care and on acti1e and passi1e e6pos're to tobacco smo-e in pregnanc2. /dds ratios and ,5= con%idence 'nits (+4) were calc'lated 'sing Jpi7n%o so%tware de1eloped b2 +@+" #tlanta" Deorgia" 4$. Gate boo-ing %or perinatal care (a%ter 12 wee- o% gestation) and less than 5 1isits d'ring pregnanc2 was %o'nd to be related to an increased ris- o% $D#" howe1er" the /; 1al'es incl'ded 'nit2. #bo't 153 o% mothers o% $D# in%ants and Mo% the controls were ser1ed mainl2 b2 the pri1ate health sector. Che 'se o% pri1ate care was related to a lower ris- o% $D#: /;I 0.55 ,5= +7 (0.31 0.,!). Chis protecti1e pattern was obser1ed in the pop'lation o% women aged 1, 25 li1ing in r'ral areas 2ears and with onl2 primar2 ed'cation. Che preconception 1isits to obstetricians and contacts with health ed'cators d'ring pregnanc2 were also %o'nd to ha1e some protecti1e e%%ect" howe1er" the /;s were not statisticall2 signi%icant. Che ad1erse e%%ect o% smo-ing d'ring pregnanc2 was clearl2 con%irmed in the st'd2 pop'lation" /;I 2.!, ,5=+7 (1.3: 5.33)" while the role o% passi1e smo-ing was di%%ic'lt to assess d'e to the small n'mber o% nonsmo-ing women e6posed to JC$. Chere are some indications that the poor 'se o% perinatal health ser1ices ma2 acco'nt %or the ele1ated ris- o% $D# births in the God9 1oi1odeship. Che 'se o% the pri1ate health sector is growing and seems to be related to a lower riso% $D# births. 3ore e%%ecti1e tools to pre1ent maternal smo-ing ha1e to be de1eloped and implemented in ro'tine perinatal care. &37@: 15:3001* A&'b3ed inde6ed %or 3J@G78JB

!1 Eo'rnal o% the college o% ph2sicians and s'rgeonsN&a-istan: E+&$& E +oll &h2sicians $'rg &a-. 2005 Ean;15(1):2! ,.
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Impact of reduced prenatal visit fre%uency on obstetric outcome in lo'3risk mot&ers.

$asnim !" Ma&mud 7" Arif MS. @epartment o% /bstetrics and D2necolog2" 3+H +enter" &a-istan 7nstit'te o% 3edical $ciences" 7slamabad. /(EJ+C7KJ: Co determine an association between red'ced prenatal 1isit %re<'encies and pregnanc2 o'tcome in women" %o'nd to be at low ris- o% obstetric complications at initial prenatal 1isit. @J$7D8: &rospecti1e cohort st'd2. &G#+J #8@ @4;#C7/8 /) $C4@O: 3other and +hild Health +enter" &a-istan 7nstit'te o% 3edical $ciences" 7slamabad. %rom Ean'ar2 to @ecember 2002. &#C7J8C$ #8@ 3JCH/@$: Che hospital case records o% 12,0 women" who were %o'nd to be at low ris- o% obstetric complications at their %irst prenatal 1isit. &renatal 1isits were categori9ed into ?>3?" ?3 !? and ?9 : 1isits gro'ps?. ?9: 1isits were ta-en as controls. Che main o'tcome meas'res were peripart'm maternal complications" obstetric inter1entions and perinatal o'tcome. ;J$4GC$: Che median n'mber o% prenatal 1isits was %o'r" (range 1 14; lower <'artile 2" 'pper <'artile !). Women with less than 3 prenatal 1isits had signi%icantl2 higher ris- o% antepart'm complications" low birth weight neonates (>2500 grams)" pre term deli1eries" neonatal morbidit2" and peri natal mortalit2. (/;: 2.5*" 2.!!" !.3" 1.5: and 2.2 respecti1el2). Howe1er" the2 were at e<'al ris- o% obstetric inter1entions and postpart'm maternal morbidit2. 8o signi%icant di%%erence was %o'nd between 3 ! 1isits and 9: 1isits gro'p" e6cept signi%icantl2 higher ris- o% preterm deli1eries in the %ormer gro'p (/;: 2.*4). +/8+G4$7/8: Gess than 3 prenatal 1isits were associated with signi%icantl2 higher incidence o% prenatal %eto maternal complications and low birth weight babies compared to : or more 1isits b't were at e<'al ris- o% obstetric inter1entions and postpart'm maternal morbidit2.Che obstetric o'tcome o% 3 ! 1isits gro'p was similar to : or more 1isits gro'p e6cept considerabl2 higher incidence o% preterm deli1eries in the %ormer gro'p. &37@: 15!:0520 A&'b3ed inde6ed %or 3J@G78JB

:1 #%rican 0o'rnal o% medicin and medical sciences #%r E 3ed 3ed $ci. 2004 E'n;33(2):145 *.

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A study of determinants of lo' birt& 'eig&t in Ab&a) Saudi Arabia.

Abdelmoneim I. )amil2 and +omm'nit2 3edicine" +ollege o% 3edicine and 3edical $ciences" Fing Fhalid 4ni1ersit2" Fingdom o% $a'di #rabia. imoneim.hotmail.com Chis st'd2 e6amined the role o% women?s wor- as a possible determinant (among others) o% low birth weight in the pop'lation o% women %ollowed in a &rimar2 Health +are (&H+) center in #bha" $o'thern $a'di #rabia. #ll antenatal care %iles %or all deli1eries in the preceding 5 2ears were st'died and the rele1ant data %rom :0!: %iles were collected and anal29ed. Gow birth weight was signi%icantl2 higher in wor-ing mothers (odds ratioI1.31)" adolescent mothers (odds ratioI 2.5!)" and low parit2 mothers (/;I 1.2*). #nemia o% the mother contrib'ted an odds ratio o% 1.23 %or low birth weight bab2 and inade<'ate antenatal care (less than 3 1isits d'ring pregnanc2) had an odds ratio o% 1.,. )emale babies were signi%icantl2 more prone to low birth weight (odds ratio 1.34). 7t is s'ggested that %'rther e1al'ation o% women?s wor- conditions to detect and remed2 stress%'l conditions especiall2 d'ring pregnancies" health ed'cation and better antenatal care ma2 pre1ent a good proportion o% low birth weight deli1eries. &37@: 155!5,33 A&'b3ed inde6ed %or 3J@G78JB

*1 +adernos de $a'de &'blica 5 3inisterio de $a'de" )'ndacao /swaldo +r'9" Jscola 8acional de $a'de &'blica +ad $a'de &'blica. 2004 $ep /ct;20(5):11!0 *. Jp'b 2004 /ct 13.
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2Ade%uacy of prenatal care and birt&'eig&t1 a systematic revie'5

A#rticle in &ort'g'eseB Silveira DS" Santos IS. @epartamento de 3edicina $ocial" )ac'ldade de 3edicina" 4ni1ersidade )ederal de &elotas" &elotas" (ra9il. denisil1eira.'ol.com.br Chis was a s2stematic literat're re1iew on p'blications in which prenatal care was in1estigated as a predicti1e %actor %or birthweight. Che 3J@G78J" +ochrane Gibrar2" and $ciJG/ databases were searched 'sing a combination o% the %ollowing 'niterms: Mprenatal careM" Mantenatal careM" M<'alit2M" Made<'ac2M" MbirthweightM" and Mlow birthweightM. Cwent2 %i1e st'dies were %o'nd: se1enteen had a cross sectional design" in addition to %o'r cohort st'dies" three case control st'dies" and one randomi9ed trial. Che ade<'ac2 indicators related to 'tili9ation (<'antitati1e meas'res) and content o% prenatal care (process or <'alitati1e indicators). 3ost a'thors emplo2ed <'antitati1e indicators" mainl2 the Fessner 7nde6 and the #de<'ac2 o% &renatal +are 4tili9ation 7nde6. P'alitati1e criteria were 'sed in onl2 two st'dies. 3ost o% the cross sectional st'dies %o'nd a protecti1e e%%ect o% prenatal care against low birthweight" whereas res'lts o% st'dies with other designs were con%licting. Chis re1iew?s %indings highlight that the impact o% prenatal care on birthweight is not 'ne<'i1ocal" mainl2 d'e to the e%%ect o% sel% selection bias. ;andomi9ed trials are needed to el'cidate s'ch a relationship. &'blication C2pes: ;e1iew &37@: 154*!!5* A&'b3ed inde6ed %or 3J@G78JB

112 $al'd &'blica de 3e6ico $al'd &'blica 3e6. 2004 Ean )eb;4!(1):23 31.

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Lo' birt& 'eig&t in Me8ico1 ne' evidence from a multi3site postpartum &ospital survey.
#rank "" Pelcastre B" Salgado de Snyder *!" #risbie 6P" Potter /" Bronfman3Pert4ovsky M!. Che /hio $tate 4ni1ersit2" +ol'mb's 43210" 4$#. reanne10.2ahoo.com /(EJ+C7KJ: Co identi%2 %actors related to cases o% low birth weight among a sample o% 3e6ican women. 3#CJ;7#G #8@ 3JCH/@$: Che present anal2sis 'tili9es data %rom a post part'm s'r1e2 o% 5!5 women implemented in eight di%%erent social sec'rit2 hospitals in western 3e6ico d'ring 2001. Women gi1ing birth to low weight in%ants (2.5 -gs) were o1ersampled and ma-e 'p hal% o% the sample. ;J$4GC$: # series o% logistic regression e<'ations are presented that estimate the ris- o% low birth weight. $t'd2 %indings indicate that" altho'gh beha1ioral %actors appear to be highl2 signi%icant in predicting the odds o% low birth weight" socioeconomic and sociodemographic %actors were %o'nd to be important in determining 'tili9ation o% prenatal care. +/8+G4$7/8$: Che -e2 role o% beha1ioral characteristics in determining low birth weight ris- and the role o% socioeconomic and sociodemographic %actors in determining prenatal care 'sage highlights the need to impro1e prenatal care 'tili9ation b2 disad1antaged pop'lations. &'blication C2pes: 3'lticenter $t'd2 &37@: 150533,3 A&'b3ed inde6ed %or 3J@G78JB

/bstetrics and g2necolog2 /bstet D2necol. 2003 8o1;102(5 &t 1):1051 :.

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7roup prenatal care and preterm birt& 'eig&t1 results from a matc&ed co&ort study at public clinics.
Ickovics "" (ers&a' $S" 6estda&l C" "ising SS" (lima C" "eynolds +" Magriples ,. @epartment o% Jpidemiolog2 and &'blic Health" Oale 4ni1ersit2 $chool o% 3edicine" 8ew Ha1en" +onnectic't 0!520 *034" 4$#. 0eannette.ic-o1ics.Oale.ed' /(EJ+C7KJ: Co e6amine the impact o% gro'p 1ers's indi1id'al prenatal care on birth weight and gestational age. 3JCH/@$: Chis prospecti1e" matched cohort st'd2 incl'ded pregnant women (8 I 45*) entering prenatal care at 24 or less wee-s? gestation; one hal% recei1ed gro'p prenatal care with women o% the same gestational age. Women were matched b2 clinic" age" race" parit2" and in%ant birth date. Women were predominantl2 blac- and Hispanic o% low socioeconomic stat's" ser1ed b2 one o% three p'blic clinics in #tlanta" Deorgia or 8ew Ha1en" +onnectic't. ;J$4GC$: (irth weight was greater %or in%ants o% women in gro'p 1ers's indi1id'al prenatal care (& > .01). #mong those born preterm" in%ants o% gro'p patients were signi%icantl2 larger than in%ants o% indi1id'al care patients (mean" 23,* 1ers's 1,,0 g" & > .05). #ltho'gh not statisticall2 signi%icant" in%ants o% gro'p patients were less li-el2 than those o% indi1id'al care patients to be low birth weight (less than 2500 g; 1! 1ers's 23 in%ants); 1er2 low birth weight (less than 1500 g; three 1ers's si6 in%ants); earl2 preterm (less than 33 wee-s; two 1ers's se1en in%ants); or to e6perience neonatal loss (none 1ers's three in%ants). Chere were no di%%erences in n'mber o% prenatal 1isits or other ris- characteristics (patient age" race" prior preterm birth). +/8+G4$7/8$: Dro'p prenatal care res'lts in higher birth weight" especiall2 %or in%ants deli1ered preterm. Dro'p prenatal care pro1ides a str'ct'ral inno1ation" permitting more time %or pro1ider patient interaction and there%ore the opport'nit2 to address clinical as well as ps2chological" social" and beha1ioral %actors to promote health2 pregnanc2. ;es'lts ha1e implications %or design o% s'stainable prenatal ser1ices that might contrib'te to red'ction o% racial disparities in ad1erse perinatal o'tcomes. &37@: 14!:24*! A&'b3ed inde6ed %or 3J@G78JB

Che 0o'rnal o% maternal %etal Q neonatal medicine E 3atern )etal 8eonatal 3ed. 2003 E'n;13(!):3!2 *0. +omment in: E 3atern )etal 8eonatal 3ed. 2003 E'n;13(!):3!1.
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Preventing lo' birt& 'eig&t1 is prenatal care t&e ans'er9

Lu MC" $ac&e *" Ale8ander 7"" (otelc&uck M" +alfon !. @epartment o% /bstetrics and D2necolog2" @a1id De%%en $chool o% 3edicine at 4+G#" Gos #ngeles" +ali%ornia" 4$#. /(EJ+C7KJ$: Co re1iew the e1idence o% e%%ecti1eness o% prenatal care %or pre1enting low birth weight (G(W). 3JCH/@$: We re1iewed original research" s2stematic re1iews" meta anal2ses and commentaries %or e1idence o% e%%ecti1eness o% the three core components o% prenatal care ris- assessment" health promotion and medical and ps2chosocial inter1entions %or pre1enting the two constit'ents o% G(W: preterm birth and intra'terine growth restriction (74D;). ;J$4GC$: +linical ris- assessment will %ail to identi%2 the ma0orit2 o% pregnancies at ris- %or preterm deli1er2 or 74D;. While bioph2sical and biochemical modalities appear promising" their cost e%%ecti1eness has not been demonstrated" nor can their ro'tine 'se be recommended in the absence o% e%%ecti1e inter1entions. $mo-ing cessation programs appear to be modestl2 e%%ecti1e. Chere is ins'%%icient e1idence to concl'de a bene%it %or n'trition inter1entions" wor- co'nseling or preterm birth ed'cation. /nl2 antenatal corticosteroid therap2 has demonstrated a clear bene%it in the tertiar2 pre1ention o% preterm deli1er2. 7nter1entions %or which there is ins'%%icient e1idence to concl'de a bene%it incl'de bed rest" h2dration" sedation" cerclage" progesterone s'pplementation" antibiotic treatment" tocol2sis witho't concomitant 'se o% corticosteroids" th2rotropin releasing hormone" ps2chosocial s'pport and home 1isitation. #dditionall2" there is a pa'cit2 o% e1idence s'pporting the e%%ecti1eness o% prenatal inter1entions" s'ch as low dose aspirin" bed rest" maternal h2pero62genation" plasma 1ol'me e6pansion and antenatal %etal assessment" in pre1enting 74D; or its associated morbidit2 and mortalit2. +/8+G4$7/8$: 8either preterm birth nor 74D; can be e%%ecti1el2 pre1ented b2 prenatal care in its present %orm. &re1enting G(W will re<'ire reconcept'ali9ation o% prenatal care as part o% a longit'dinall2 and conte6t'all2 integrated strateg2 to promote optimal de1elopment o% women?s reprod'cti1e health not onl2 d'ring pregnanc2" b't o1er the li%e co'rse. &'blication C2pes: ;e1iew &37@: 12,!22!1 A&'b3ed inde6ed %or 3J@G78JB 15, ;e1ista de $a'de &'blica

;e1 $a'de &'blica. 2003 E'n;3:(3):303 10. Jp'b 2003 E'n 3.

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2Prenatal care) lo' birt& 'eig&t and prematurity in Sao Paulo State) Bra4il) :;;;5
A#rticle in &ort'g'eseB (ils4ta-n S" "ossbac& A" do Carmo MS" Suga&ara 7$. Gaboratorio de Jconomia $ocial do &rograma de Jst'dos &os Drad'ados em Jconomia &olitica da &onti%icia 4ni1ersidade +atolica de $ao &a'lo" $ao &a'lo" $&" (rasil. s-il.p'csp.br /(EJ+C7KJ: Che historical e1ol'tion o% in%ant mortalit2 rate and neonatal mortalit2 according to birth weight and term o% deli1er2 in the state o% $ o &a'lo are presented to assess the role o% the n'mber o% prenatal 1isits and others %actors %or determining mortalit2. 3JCH/@$: (ased on data a1ailable %rom the $eade 7nstit'te o% Kital $tatistics" %o'r 1ariables (maternal age" marital stat's" ed'cation" and childbirth order) were anal29ed and di1ided into two categories according to the relati1e ris- o% low birth weight and5or preterm pre1alence. $i6teen speci%ic gro'ps were created %rom crossing the %o'r 1ariables into two categories. Gow birth weight and5or preterm pre1alence per n'mber o% prenatal 1isits and the relati1e ris- were calc'lated %or all si6teen gro'ps. ;J$4GC$: )or all si6teen gro'ps" the higher the n'mber o% prenatal 1isits the lower the pre1alence o% low birth weight and5or premat'rit2. #dditionall2" there was an o1erall red'ction o% the di%%erence o% low birth weight and5or preterm pre1alence among the 1! gro'ps %rom 14= to 4= with an increase %rom 0 3 to : 1isits or more. +/8+G4$7/8$: @'e to the c'rrent in%ant mortalit2 composition in the state o% $ao &a'lo" increasing the n'mber o% prenatal 1isits and accessibilit2 o% women at ris- wo'ld probabl2 lead to a red'ction in intra'terine growth retardation" premat'rit2" low birth weight and deaths associated to conditions originated in the perinatal period. &37@: 12:,2!*0 A&'b3ed inde6ed %or 3J@G78JB

1!! Eo'rnal o% health care %or the poor and 'nderser1ed E Health +are &oor 4nderser1ed. 2003 3a2;14(2):2:2 *,.
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Prenatal care and infant birt& outcomes among Medicaid recipients.

7uillory * " Samuels M/" Probst C" S&arp 7. @epartment o% &re1enti1e 3edicine" 4ni1ersit2 o% Health $ciences" Fansas +it2" 3isso'ri" 4$#. 7n%ant morbidit2 d'e to low birth weight and preterm births res'lts in emotional s'%%ering and signi%icant direct and indirect costs. #%rican #merican in%ants contin'e to ha1e worse birth o'tcomes than white in%ants. Chis st'd2 e6amines relationships between newborn hospital costs" maternal ris- %actors" and prenatal care in 3edicaid recipients in an impo1erished r'ral co'nt2 in $o'th +arolina. 3edicaid #%rican #merican mothers ga1e birth to %ewer preterm in%ants than did non 3edicaid #%rican #merican mothers. 8o di%%erences in the rates o% preterm in%ants were noted between white and #%rican #merican mothers in the 3edicaid gro'p. #ccess to 3edicaid ser1ices ma2 ha1e contrib'ted to this red'ction in disparities d'e to race. Jarl2 initiation o% prenatal care compared with later initiation did not impro1e birth o'tcomes. 7n%ants born to mothers who initiated prenatal care earl2 had increased morbidit2 with increased 'tili9ation o% hospital ser1ices" s'ggesting that high ris- mothers are entering prenatal care earlier. &37@: 12:3,305 A&'b3ed inde6ed %or 3J@G78JB

1!* Eo'rnal o% comm'nit2 health E +omm'nit2 Health. 2003 E'n;2*(3):1,, 20*.

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Delayed prenatal care and t&e risk of lo' birt& 'eig&t delivery.
+ueston 6 " 7ilbert 7/" Davis L" Sturgill *. @epartment o% )amil2 3edicine" 3edical 4ni1ersit2 o% $o'th +arolina" +harleston" $+ 2,425" 4$#. h'estonw0.m'sc.ed' Co determine i% the timing o% prenatal care is associated with low birth weight deli1er2 a%ter ad0'sting %or sociodemographic and beha1ioral ris- %actors" we per%ormed a retrospecti1e cross sectional st'd2 o% singleton births to white (2",45"5,5) or #%rican #merican (552"0!*) women in the 4nited $tates in 1,,!. When ad0'sted %or race" maternal age" ed'cational le1el attained" and the 'se o% alcohol and tobacco d'ring pregnanc2" women beginning care in the 2nd (ad0'sted ;; I 0.*5; ,5= +7: 0.*3 0.*!) and 3rd trimesters (;; I 0.*:; ,5= +7: 0.*4 0.,1) had a red'ced ris- o% low birth weight compared to women beginning care in the 1st trimester. /'r %indings s'ggest that no bene%it e6ists %or earl2 initiation o% prenatal care %or red'cing the ris- o% low birth weight. )indings related to di%%erences in low birth weight among women who start prenatal care later are li-el2 d'e to sociodemographic di%%erences that ma2 in%l'ence access to earl2 care. &37@: 12:130:0 A&'b3ed inde6ed %or 3J@G78JB

1*4 J'ropean 0o'rnal o% obstetrics" g2necolog2 and reprod'cti1e biolog2 J'r E /bstet D2necol ;eprod (iol. 2003 Ean 10;10!(1):40 ,.
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Antenatal visits and adverse perinatal outcomes1 results from a Britis& population3based study.
Petrou S" (upek /" *ause S" Mares& M. 8ational &erinatal Jpidemiolog2 4nit" 7nstit'te o% Health $ciences" 4ni1ersit2 o% /6%ord" /ld ;oad" Headington" /R3 :G)" /6%ord" 4F. sta1ros.petro'.perinat.o6.ac.'/(EJ+C7KJ: Che ob0ecti1e o% this st'd2 was to e6plore the relationship between the n'mber o% antenatal 1isits made b2 a representati1e sample o% (ritish women and ad1erse perinatal o'tcomes. $C4@O @J$7D8: # total o% 20"::1 women with a singleton pregnanc2 were recr'ited %rom nine representati1e maternit2 'nits in 8orthern Jngland and 8orth Wales. # record o% each woman?s antenatal care and the ad1erse perinatal o'tcomes o% interest were e6tracted retrospecti1el2 %rom their case notes. 3'lti1ariate binomial regression was 'sed to model the probabilit2 o% ad1erse o'tcomes with respect to the absol'te n'mber o% antenatal 1isits" a%ter controlling %or potentiall2 con%o'nding %actors. $eparate anal2ses were per%ormed %or primiparae and m'ltiparae" and %or low and high ris- women within each paro's gro'p. ;J$4GC$: Che st'd2 re1ealed an in1erse association between the n'mber o% antenatal 1isits and deli1er2 o% a low birthweight in%ant" in%ant admission to a special care bab2 'nit and perinatal mortalit2 o1er the 4 14 antenatal 1isit range" which dissipated at higher le1els o% antenatal 1isits. Che st'd2 also re1ealed a signi%icant positi1e association between the n'mber o% antenatal 1isits and deli1er2 b2 caesarean section (&>0.01). $imilar trends in the probabilities o% ad1erse o'tcomes were obser1ed %or low and high ris- women within each paro's gro'p. +/8+G4$7/8: )'rther e6perimental research is re<'ired to ascertain whether a ca'sal relationship e6ists between antenatal 1isiting sched'les and ad1erse perinatal o'tcomes. &37@: 124:55*0 A&'b3ed inde6ed %or 3J@G78JB

1,5 ;e1ista panamericana de sal'd pSblica ;e1 &anam $al'd &'blica. 2002 $ep;12(3):1*0 4.
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2"isk factors for lo' birt&'eig&t in a Cuban &ospital) <==>3:;;;5

A#rticle in $panishB /scobar A" Darias LS" /spinosa MA" Castaneda Lde "" +errera ?7" 7arcia !P" "abelo ML. )ac'ltad de +iencias 3edicas" $ancti $pirit's" +'ba. cabrales.escambra2.ssp.sld.c' /(EJ+C7KJ: Co determine what maternal ris- %actors that are present d'ring pregnanc2 are associated with low birthweight (less than 2 500 g). 3JCH/@$: # case control st'd2 was cond'cted with :!4 prod'cts o% single births weighing less than 2 500 g at birth" and 1 43: controls %rom Hospital Dineco /bstetrico &ro1incial in $ancti $pirit's" +'ba" d'ring the 1,,: 2000 <'adrenni'm. Che data were obtained %rom clinical records" reports o% labor" and personal inter1iews with mothers. # bi1ariate anal2sis was per%ormed" and possible con%o'nders were controlled %or thro'gh dichotomo's logistic regression 'sing $&$$. # %inal m'lti1ariate statistical model 'sed was to identi%2 maternal ris%actors %or low birthweight. ;J$4GC$: Che res'lts o% m'lti1ariate anal2sis showed a signi%icant association between low birthweight" the presence o% anemia when the pregnanc2 was detected" 'rinar2 tract in%ection d'ring pregnanc2" bronchial asthma" total maternal weight gain 'nder * -g d'ring pregnanc2" smo-ing while pregnant" a histor2 o% pre1io's children with low birthweight" arterial h2pertension since be%ore pregnanc2" and inade<'ate timing o% 1isit %or %ollow 'p o% initial prenatal care. +/8+G4$7/8$: /n the basis o% these res'lts it was concl'ded that" regardless o% the impact meas'rement method 'sed" it is important to tr2 to red'ce the ris- %actors identi%ied in the st'd2 in order to lower the incidence o% low birthweight in the pro1ince o% $ancti $pirit's. &37@: 123,!!3! A&'b3ed inde6ed %or 3J@G78JB

&;/P4J$C
Measurement Error in Prenatal Care Utilization: Evidence of Attenuation Bias in the Estimation of Impact on Birth Weight John R. Penrod, Paula M. Lantz. Maternal and Child Health ournal! New York: Mar 2000. Tomo 4, No. 1; p !. "#
"esumen

$%&'ecti(e:$ )rrors in t*e meas+rement o, t*e timin! and n+m&er o, prenatal care (isits maprod+ce downward &ias in estimates o, t*e impact o, prenatal care +se on &irt* o+tcomes. T*is paper e.amines t*e e.tent o, atten+ation &ias ,rom meas+rement error in t*e estimation o, t*e e,,ect o, prenatal care +se on &irt* wei!*t. $Met*ods:$ /ata were anal-0ed ,rom t*e 1#10 National Natalit2+r(e-, a nationall- representati(e sample o, li(e &irt*s wit* in,ormation on prenatal care +tili0ation ,rom t*ree so+rces: &irt* certi,icates, medical pro(ider s+r(e-s, and maternal s+r(e-s. T*e e.tent o, atten+ation &ias in estimates o, t*e impact o, di,,erent meas+res o, prenatal care +se on &irt* wei!*t was e.amined &- comparin! estimates ro&+st to meas+rement error 3incl+din! instr+mental (aria&les4 wit* ordinar- least s5+ares res+lts. $Res+lts:$ T*ere is considera&le disa!reement in meas+res o, prenatal care across t*e t*ree data so+rces, wit* correlations in t*e +tili0ation meas+res comp+ted ,rom di,,erent so+rces aro+nd 0.6. T*e res+lts also s*ow e(idence o, atten+ation &ias ,rom meas+rement error in estimates o, t*e impact o, prenatal care on &irt* wei!*t ,or &ot* 7*ite and 8lack mot*ers. Atten+ation &ias was least se(ere ,or in,ormation ,rom t*e &irt* certi,icate report o, prenatal care. $9oncl+sions:$ 8eca+se o, meas+rement error, pre(io+s st+dies ma- *a(e +nderestimated t*e e,,ect o, prenatal care +tili0ation on &irt* wei!*t. 9orrected estimates, *owe(er, do not s+!!est t*at prenatal care is a ma'or predictor o, &irt* wei!*t. :n addition, part o, w*at pre(io+s anal-ses *a(e interpreted as ad(erse selection &ias ma- in ,act &e atten+ation &ias d+e to meas+rement error.