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October 6, 1993

The Association Between Prenatal Care and Birth Weight Among Women Exposed to Cocaine in New York City

Author Affiliations

From the Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Racine); National Bureau of Economic Research, New York, NY (Drs Racine and Joyce); Department of Economics and Finance, Baruch College, City University of New York (NY) (Dr Joyce); and Department of Economics, State University of New York at Farmingdale (Dr Anderson).

JAMA. 1993;270(13):1581-1586. doi:10.1001/jama.1993.03510130087036

Objectives.  —Although the association between antenatal cocaine use and adverse birth outcomes has been well documented, relatively little is known about interventions that may ameliorate these consequences. We therefore examined the relationship between prenatal care and birth weight among a population of prenatal cocaine users.

Design.  —Population-based retrospective analysis.

Patients.  —All single-gestation live births to white non-Hispanic, black non-Hispanic, and Hispanic residents of New York City who gave birth between 1988 and 1990 with a positive indication for cocaine recorded on birth certificates (N=7923).

Main Outcome Measures.  —We contrasted mean birth weight and rates of low birth weight (<2500 g) among cocaine users with one to three prenatal care visits, four or more visits, and unknown numbers of visits with users who reported no prenatal care. We used ordinary least squares and logistic regression to control for age, parity, smoking, alcohol, other drugs, weight gain, prepregnancy weight, employment, marital status, participation in the Supplemental Food Program for Women, Infants and Children, and method of finance.

Main Results.  —Adjusted odds ratios of low birth weight for cocaine users with four prenatal care visits or more as compared with those who had none were 0.51 for blacks (95% confidence interval [CI], 0.44 to 0.59), 0.39 for whites (95% CI, 0.23 to 0.66), and 0.37 for Hispanics (95% CI, 0.28 to 0.48). Adjusted mean birth weight differences between users with four visits or more and those with none were 262 g for blacks (P<.001), 247 g for whites (P<.001), and 317 g for Hispanics (P<.001).

Conclusions.  —The receipt of prenatal care among cocaine users is associated with significant improvements in birth weight. Enrollment of cocaine users in prenatal care may be an effective start to a more comprehensive approach to this problem.(JAMA. 1993;270:1581-1586)