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Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups. | LitMetric

Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups.

J Midwifery Womens Health

Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine and Global Health Initiative, College of Health Sciences and Professions, Dublin, Ohio.

Published: December 2024

AI Article Synopsis

  • Preterm birth and small for gestational age (SGA) are significant health issues in the U.S., emphasizing the need for better prenatal care assessments, leading to the development of the Comprehensive Prenatal Care Index (CPCI).
  • This study analyzed data from over 139,000 pregnant women using the CPCI and found it to be a reliable measure of prenatal care quality, associating higher CPCI scores with reduced risks of adverse birth outcomes like preterm birth and SGA.
  • Results indicate that comprehensive prenatal care, as evaluated by the CPCI, is particularly effective in lowering risks for non-Hispanic White, Hispanic, and Asian women, highlighting its potential to address disparities in maternal health across racial and ethnic groups.

Article Abstract

Introduction: Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion.

Methods: This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices.

Results: The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups.

Discussion: The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622361PMC
http://dx.doi.org/10.1111/jmwh.13707DOI Listing

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