From the Department of Maternal and Child Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.
In this issue of THE JOURNAL, Kogan and colleagues1
identified trends in the patterns of prenatal care utilization in the United
States from 1981 through 1995. Four measures of utilization were examined.
First, the authors examined patterns based on the trimester that care began
and the Institute of Medicine (IOM) Index of Adequacy of Care (Kessner Index).2 Clearly, the trimester that care began is an inadequate
measure of prenatal care use because neither the total number of visits nor
the number of visits relative to the length of gestation is incorporated.
While the IOM Index does consider the number of visits, it has been criticized
for failing to incorporate the full length of gestation in considering the
adequacy of the number of visits. Second, because both these older indices
had limitations, the authors also chose to examine patterns of prenatal care
utilization using 2 newer measures: R-GINDEX3
and Adequacy of Prenatal Care Utilization (APNCU) Index.4,5
Both of these measures include a category of "intensive utilization" to categorize
women who receive more than the recommended number of visits. Based on these
newer indices, the authors report that utilization of prenatal care, especially
intensive utilization, has been increasing steadily since 1981. The same relationship
was not identified using the 2 older indices, with utilization just beginning
to increase, only slightly, during the 1990s.
Misra DP, Guyer B. Benefits and Limitations of Prenatal CareFrom Counting Visits to Measuring Content. JAMA. 1998;279(20):1661-1662. doi:10.1001/jama.279.20.1661