Prenatal Care

Although it is widely believed that prenatal care is associated with better birth outcomes, the actual association is more complex. Early case-control/correlational research in the 1960s and 1970s generally showed a small positive association between increased medical prenatal care and decreased low birthweight and infant mortality. More recent, rigorous studies, however, have not generally demonstrated significant associations with improved birth outcomes.

Several factors complicate this widely assumed positive association. First, the association between prenatal care visits and birth outcomes is not linear but U-shaped. Both less (inadequate) care and more (possibly medically needy) care are associated with increased poor birth outcomes. Second, women who participate in prenatal care enhancement programs may be a more self-selected group of health-conscious women, a factor that may be more important to improving birth outcomes than their use of more enhanced prenatal care. Third, research has not consistently demonstrated a strong impact of psychosocial factors on LBW, prematurity, and infant mortality. Much attention has shifted to the role of infectious diseases, such as bacterial vaginosis, in occurrences of prematurity, an example of a biologic factor in contrast to social factors. Fourth, almost all the late twentieth century improvements in infant mortality rates resulted from improvements in keeping LBW babies alive through improved neonatal care, not the prevention of low birthweight infants (the presumed pathway of prenatal care). And finally, there has been an increase in LBW and prematurity rates in the United States, despite simultaneous broad improvements in prenatal care overall. The policy and programmatic enthusiasm of the 1980s and 1990s for access to comprehensive prenatal care to address poor birth outcomes and racial disparities had greatly diminished by the early twenty-first century.