Margaret A.WinkerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor
To the Editor.—We wish to clarify some misconceptions in the Editorial1 accompanying our article on the changing pattern of prenatal care utilization in the United States.2 In the Editorial, Drs Misra and Guyer erroneously concluded that women most at risk for poor perinatal outcomes did not have increased utilization. They looked at our logistic models for factors associated with intensive utilization in 1981 and 1995, saw that African American women and women with less education were less likely than white women and women with more education to receive intensive utilization in 1995, and concluded that "2 of the groups that are socially at high risk . . . did not share in the trend toward increased utilization of prenatal care at the intensive levels." In fact, the rates increased markedly for both groups. Intensive utilization increased 40% for women with less education (compared with 55% for women with some college) and 72% for African American women (compared with 89% for white women).
Kogan MD, Martin JA, Ventura SJ, Alexander GR, Kotelchuck M, Frigoletto FD. Benefits and Limitations of Prenatal Care. JAMA. 1998;280(24):2071–2073. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-24-jbk1223