Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups.
Sueny P Lima Dos Santos, Eric E Calloway, Ilana R A Chertok and 1 others
PMID 39593248WHAT IT FOUND
Comprehensive prenatal care quality, including counseling and screening content, was associated with lower odds of preterm birth across racial and ethnic groups.
It did not consistently predict small for gestational age. Visit count alone did not capture care quality.
Key findings
01Prenatal care classified as intermediate or adequate on the new index was associated with lower odds of preterm birth than inadequate care across racial and ethnic groups.
02For small for gestational age, the new index was associated with lower odds among White women (0.86 for intermediate and adequate care), but not among Black women (1.02 and 0.93).
03The traditional Kotelchuck adequate plus category was associated with higher odds of preterm birth in all groups, reaching 2.42 among Hispanic women.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational and self-reported, so it cannot show that giving more prenatal counseling or screening caused fewer preterm births. The data came from 2016 to 2021, including the pandemic, which changed prenatal care delivery and access. PRAMS lacks clinical details such as blood samples, blood pressure monitoring, and specific interventions, so it cannot capture all care quality. The sample was mostly non-Hispanic White women (60.7%), so results may not apply to more diverse populations. The index did not distinguish individual women's prenatal care quality well, with person reliability 0.36. Most index items functioned differently across racial and ethnic groups, so scores may not mean the same thing for all groups. The new index was tested only on the same data set from which it was built, so it may not hold up in other data.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not read the lower odds of preterm birth as proof that adding counseling or screening during prenatal visits prevents preterm birth. This was an observational survey analysis, and the index did not distinguish individual women's care quality well, with a reliability score of 0.36.