Related Experiment Video
Updated: Jun 6, 2025
A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for
Sueny P Lima Dos Santos1,2, Eric E Calloway2, Ilana R A Chertok1
1Graduate College, Ohio University College of Health Sciences and Professions, Athens, Ohio.
Insights
A new Comprehensive Prenatal Care Index (CPCI) offers a better way to measure prenatal care quality. This improved assessment shows comprehensive care significantly reduces preterm birth and small for gestational age risks.
Area of Science:
- Maternal and Child Health
- Public Health Research
- Healthcare Quality Improvement
Background:
- Preterm birth and small for gestational age (SGA) are critical public health issues in the US, marked by significant racial and ethnic disparities.
- Existing prenatal care adequacy indices inadequately capture the complexity of care quality.
- The Comprehensive Prenatal Care Index (CPCI) was developed to offer a more holistic evaluation of prenatal care, integrating counseling and health promotion.
Purpose of the Study:
- To introduce and validate the Comprehensive Prenatal Care Index (CPCI) for a more thorough assessment of prenatal care quality.
- To evaluate the association between CPCI scores and adverse birth outcomes, including preterm birth and SGA.
- To explore the CPCI's potential in addressing racial and ethnic disparities in maternal and child health.
Main Methods:
- Utilized cross-sectional data from the Pregnancy Risk Assessment Monitoring System (2016-2021), including 139,181 pregnant women.
- Developed the CPCI based on literature review, incorporating timing, frequency, and content of prenatal visits.
- Validated the CPCI using Item Response Theory (IRT) and compared it with existing indices (Kotelchuck, Kessner).
Main Results:
- The CPCI demonstrated strong internal consistency (Cronbach's α = 0.75, ω total = 0.81) and IRT-confirmed variability capture.
- Higher CPCI scores were significantly associated with reduced odds of adverse birth outcomes.
- Adequate CPCI care reduced preterm birth odds by 63% in non-Hispanic White women and showed similar protective effects across other racial/ethnic groups; protective effects for SGA varied by group.
Conclusions:
- The CPCI serves as a more inclusive measure of prenatal care quality than traditional indices.
- Comprehensive prenatal care, as measured by the CPCI, plays a crucial role in mitigating adverse birth outcomes and reducing health disparities.
- Further research is recommended to refine the CPCI and assess its utility in diverse populations for targeted prenatal care strategies.
Introduction:
Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion.
Methods:
This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices.
Results:
The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups.
Discussion:
The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.
Related Concept Videos
01:30Preventive Healthcare Services
01:07Teratogenicity