Margaret A.WinkerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor
To the Editor.—In 1985 the Institute of Medicine recommended "a broad national commitment to ensuring that all pregnant women, especially those at socioeconomic or medical risk, receive high-quality prenatal care."1 This recommendation was based on evidence that prenatal care reduces low birth weight, especially among high-risk women.1 Yet Dr Kogan and colleagues2 discerned a steady increase in use of prenatal care between 1981 and 1995, a period during which there was no reduction in low birth weight or preterm births and steady increases in the rate of very low birth weight.2,3 They referred to this situation as a paradox. In an accompanying Editorial,4 Drs Misra and Guyer noted that social factors explain much of the variation in pregnancy outcomes in the United States and that African American and low-income women did not share in the trend toward increased intensive use of prenatal care between 1981 and 1995. This letter suggests other possible explanations for the paradox.
Rooks JP. Benefits and Limitations of Prenatal Care. JAMA. 1998;280(24):2071-2073. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-24-jbk1223