The relationship of prenatal care utilization and tobacco and alcohol use to perinatal and neonatal outcomes: A secondary analysis

Abstract

1991 birth and death certificate information for Maryland state residents was used to examine the relationship of entry into prenatal care and number of follow-up visits to the birth outcomes of gestational age, birthweight and neonatal and postneonatal mortality. The impact of maternal race, age, education, marital status, pregnancy history and behaviors were also investigated. The live birth file contained 42,019 cases; 64% were white and 36% were black. Women in the sample ranged in age from 12 to 48 years with an average age of 26.5 years. The linked infant birth/death file contained 227 cases; 60% of the infants died in the neonatal period and 40% died postneonatally. Black infants comprised 66% of the infant deaths and white infants comprised 33%. Correlational analyses, logistic regression analyses and hierarchical multiple regression analyses were used to address the research questions. Analyses were computed for the total sample and sub samples of white and black women. Alcohol use was significantly correlated with age of infant death for the total sample and for whites but not for blacks. Tobacco use was not significantly correlated with infant death. Women in the total sample and black women who used tobacco and alcohol tended to have low birthweight and low gestational age infants. For whites, tobacco use was related to low gestational age and low birthweight. Logistic regression analyses showed that women who had more prenatal visits were more likely to have infants who died postneonatally. Time of entry into prenatal care had no effect on timing of infant death. Hierarchical multiple regression models were better able to explain variance in birthweight verses gestational age. Having prenatal care and more prenatal follow-up visits were found to be significant predictors of high gestational age and birthweight for the total sample, blacks and whites. The impact of the maternal demographics, pregnancy history and maternal behavior variables were found to vary by race. Implications for health care providers rendering prenatal care are discussed.