The impact of the source of prenatal care on birth outcome in low-income women: A retrospective study of live births in Louisiana, 1997--1998
Description
The purpose of this study was to explore if the source of prenatal care was associated with different birth outcome of gestational age and birth weight in low-income Louisiana women in 1997 and 1998. Women who used prenatal care at parish health units (state run clinics) from advanced practice nurses were compared to similar women who received care most likely from private providers, usually physicians. Previous studies have shown that prenatal care provided to medically low-risk women by nurses was associated with the same likelihood for optimal birth weight as care provided by physicians The data from this study came from three sources: Louisiana live birth certificates, Louisiana Medicaid monitoring and billing system (n = 36,800) and the Louisiana Pregnancy Risk Assessment Surveillance System (n = 826). All of the women in this study delivered a live singleton birth in 1997 or 1998, did not have pre-pregnancy high blood pressure or diabetes, and they received WIC (nutrition supplementation) during pregnancy The source of prenatal care was statistically significantly associated with birth outcome in the bivariate analysis. Women who received prenatal care from other providers were more likely than those who received care from PHUs to have an optimal birth outcome (OR = 0.86, 95% CI[0.81--0.91], p = 0.000). However, in the muItivariate analysis, after adjusting for differences in social and demographic characteristics, there was no statistical association between the type of provider and birth outcome The PHUs were more likely to have patients who had social and demographic characteristics that have also been identified by other studies as being associated with greater risk of low birth weight. The PHU's clients were more likely to be African American, 17 years old or younger, less than 12 years of education, not married, be under 130 percent of the federal poverty level, to have smoked and drank alcohol during pregnancy. Each one of these characteristics was statistically significantly associated with sub-optimal birth outcome in this study Further research on pregnancy and birth outcomes in a more diverse group of African American women would increase our understanding of the factors associated with pregnancy outcomes within this group of women