Perinatal Indicators Prenatal Care
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Prenatal care refers to care related to a pregnancy. The goal of prenatal care is to help the pregnant woman achieve physical, nutritional and psychosocial well-being and have a healthy outcome of pregnancy. Prenatal care strives to achieve the best possible health and outcomes for both the mother and infant.
In 1989 the Expert Panel on the Content of Prenatal Care outlined the objectives of prenatal care as "to promote the health and well-being of the pregnant woman, the fetus, the infant, and the family up to one year after the infant's birth.1
Women who begin prenatal care from the first few weeks of pregnancy and continue throughout the pregnancy have the healthiest pregnancies and babies.
It is recommended that all women planning pregnancy receive a "preconception visit" prior to becoming pregnant and initiate prenatal care services in the first trimester of pregnancy. First trimester is defined as from conception to 13 weeks gestation.
• Gestational age at the first prenatal visit is tracked nationally as a measure of good health.
• The Public Health Services Healthy People 2010 goal is to increase the number of women who begin prenatal care in the first trimester to at least 90%.
• Current rates of first trimester prenatal care are 83.7% in the US and 86.4% in California and 87.6% in LA County.
• Other measures are needed to assess the quality of prenatal care.
A comprehensive team approach to prenatal care is essential to obtain quality pregnancy outcomes.
• The process of prenatal care should include not only risk based medical management but also risk assessment in the areas of the psychosocial, nutritional, behavioral, and health education to identify the needs of the woman and her family.
• This ongoing comprehensive risk assessment should take place at least once during each trimester. Referrals, consultation and transfer of care should be considered throughout all trimesters of pregnancy as determined by condition and/or development of risk factors.
• Prenatal care should be provided in a non-biased, nonjudgmental and culturally competent environment.
• Expectations of care should be discussed during the first prenatal visit to establish a trusting relationship between the patient and the provider.
The California Department of Health Services defines Adequacy of Prenatal Care Utilization (APNCU) as care initiated during the first four months of pregnancy, followed by greater than or equal to 80% of the expected total number of visits recommended by the American College of Obstetricians and Gynecologists (ACOG), adjusted for the length of gestation.2,3 For a full-term (40-week) pregnancy with no complications, ACOG recommends prenatal-care visits "...every 4 weeks for the first 28 weeks of pregnancy, every 2-3 weeks until 36 weeks of gestation, and weekly, thereafter, although flexibility is desirable".2,3
It is important to note that neither following the gestation at onset of prenatal care, the number of visits recommended by ACOG nor the Kotelchuck-APNCU index measures or assess the content of prenatal care either in terms of medical care provided or the influence of complimentary support services such as health education, psychosocial support, nutritional counseling and/or case management. Additionally, none of the measures take into account variations in care related to maternal health prior to or during pregnancy.
What does this mean for Los Angeles County?
• In 2002, 87.6% of live births in Los Angeles County were born to women who received prenatal care in the first trimester of pregnancy.
• Onset of prenatal care varies by ethnicity, maternal age, source of payment for care, and region of Los Angeles County.
•Whites had the highest rates of early prenatal care (92.8%), followed by Asian and Pacific Islanders (89.7%), Hispanics (86.5%), American Indians (85.8%), and African Americans (83.1%).
• In 2002, 72.8% of LA County adolescents < 18 years of age received care during the first trimester.
• The proportion of women with early prenatal care increases with maternal age, with women over age 35 reaching the Healthy People 2010 goal of 90% with first trimester prenatal care.
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2002 Data
First trimester onset of Prenatal care in
LA County, CA, and U.S.
- by Race/Ethnicity First trimester onset of prenatal care LA County
by SPA
by Maternal Age
by Source of Payment
by Zip Code for each SPA
Trends in First Trimester Prenatal Care for LA County, 1993-2002
Trends in First Trimester Prenatal Care by SPA
LAC-DHS, Maternal, Child & Adolescent Programs
The Children's Planning Council: Onset of Prenatal Care by SPA, zipcode, and community
2001 Data
For additional data on Onset of Prenatal Care in LA County, and California, please see the following websites:
United Way of Greater Los Angeles: Onset of Prenatal Care by SPA, zipcode, and community
Online queries can be run for birthweight categories, prenatal care onset, ethnicity, and maternal age for LA County data on the State of California, Department of Health Services website:
Data on birth rates in LA County and California can be found at the March of Dimes-Peristats website.
2000 Data
Trends in First Trimester Prenatal Care for LA County and California - Anne E. Casey Foundation-Kids Count
References
1. Expert Panel on the Content of Prenatal Care. The Content of Prenatal Care. Washington, DC: US Govt Printing Office, 1989.
2. Guidelines for Perinatal Care, 5th Edition, ACOG and AAP.
3. Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994;84:1414-20.
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