To the Editor.
—The article by Dr Kogan and colleagues1 attempts to answer an oft-repeated question: What component of prenatal care leads to improved outcome of the newborn? The authors appropriately cite multiple sources that indicate that adequate utilization of prenatal care is associated with improved birth weight and lower risk of preterm delivery. The article suggests that "sufficient health behavior advice" lowers the risk of delivering low-birth-weight infants. Despite the large number of patients surveyed by questionnaire and the appropriate statistical analysis of their study, I am not convinced that any message or teaching, no matter how dynamic or well conceived, has a direct organic impact on the successful outcome of pregnancy. Enthusiasm and effort by obstetricians and related health care providers are, indeed, associated with improved access to the health care system for pregnant women and better outcomes.2 However, the variability in training, experience, and other
Wallach RC. What Component of Prenatal Care Is Responsible for Improved Outcome?. JAMA. 1995;274(8):611-612. doi:10.1001/jama.1995.03530080027031