The Effect of Prenatal Care and Other Factors on Preterm Births in Montgomery County 2007-2009

Introduction Preterm birth is defined as a baby who is born before 37 weeks of pregnancy. Problems with preterm birth include an increased risk for health complications throughout life as well as having significantly more medical expenses compared to a full term infant. Prenatal care has shown to decrease the risk for preterm birth nationally. The objective of this project was to analyze prenatal care and other risk and demographic factors to determine their association with preterm birth in Montgomery County. Method Data used included the 2007-2009 Montgomery County Birth Certificate Data for mothers who had singleton births. The Kessner Index was used to assess the adequacy of prenatal care. Finally, a logistical regression was conducted to determine significant associations between demographic and risk factors with preterm birth. Results The significant risk factors for preterm birth in Montgomery County included: lower education, prenatal diabetes, prior preterm birth, older maternal age, and African American race. Those who did not have adequate prenatal care were also more likely to have a preterm birth than a full term birth. Conclusion Overall results of the Kessner index showed that 98.89 % utilized an adequate amount of prenatal care, 0.72% were classified as using an intermediate amount of prenatal care and 0.39% had utilized an inadequate amount of prenatal care. Other findings were consistent with other research except that smoking status, while a risk factor, was not a significant risk factor; this should be researched further. In addition, since inadequate prenatal care was a risk factor for preterm birth, more research is warranted into determining reasons why mothers may not utilize prenatal care. 3 PRENATAL CARE AND PRETERM BIRTH Introduction Preterm birth is defined as a baby who is born before 37 weeks of pregnancy. In 2006, prematurity and low birth weight (<2500 g) accounted for 17% of all infant deaths in the United States. It is the number one cause of infant mortality in the United States. In addition, preterm infants are also at an increased risk of health complications including breathing problems, intestinal issues, and neurological deficits. There is also increased risk of long-term disabilities including intellectual deficits, behavioral problems, cerebral palsy, vision loss and hearing loss (Prematurity Research). It is not only problematic emotionally for the family involved, it is also burdensome financially for both the family and the economy. According to the March of Dimes, in 2009 the average medical costs for a preterm baby were more than 10 times higher than when a woman had a healthy full-term infant. The average costs for preterm infants and full-term infants were $49,033 and $4,551 respectively (Preterm Birth Overview). Identifying risk factors allow public health and medical professionals to focus on specific interventions that will help to prevent the occurrence of preterm birth, which is problematic for both families as well as our health care system. There are various risk factors for preterm birth, some have been found to be highly correlated with the risk of preterm birth, while others are only mildly to moderately associated with preterm birth. Maternal health conditions and pregnancy related problems which increase the risk for preterm birth include gestational diabetes, a history of preterm delivery, plurality (multiple births in a single pregnancy), and hypertension, diabetes, and prenatal infection. Social and biological factors that can put a mother and her baby at risk for preterm delivery are African American ethnicity, multiple births, an underweight or overweight mother, a maternal age younger than 16 or older than 35, lack of prenatal care, low socioeconomic status, unmarried status, and tobacco use. This study will assess documented risk factors that have been shown to 4 PRENATAL CARE AND PRETERM BIRTH have at least a moderate correlation with preterm birth and that are available on the birth certificate. Statement of Purpose or Research Question There are numerous research studies showing that prenatal care is beneficial for the treatment of obstetric conditions including hypertension and diabetes. It has also shown to be a cost-effective way to prevent long-term health problems for the mother and infant. However, little data is available on the direct benefit to reducing the likelihood of a preterm birth (Krueger & Scholl, 2000). In addition, the research that has been conducted is outdated. Given that prenatal care has changed due to technological advances as well as breakthroughs in research, it is important to show the current relationship between prenatal care and its relationship to preterm birth rates. The purpose of this research is to evaluate the effect of prenatal care on the likelihood of a mother having a preterm birth infant (<37 weeks) or a full term birth infant (37 weeks +) in Montgomery County from 2007-2009. Additional risk factors that will be included in the analysis include previous preterm birth, plurality, hypertension, diabetes, prenatal infections, maternal age, race, socio-economic status, marital status, maternal weight, and smoking status of the mother. Review of Literature The goal of this research is to establish whether there is a direct relationship between the utilization of prenatal care and preterm birth. Therefore, it is important that we look at the many risk factors related to preterm births to try to reduce the effect of any confounding variables that may alter the data analysis. The risk factors for preterm birth can be broken up into two categories: 1) Medical Risk Factors and 2) Social and Demographic Factors. Table 1, below, outlines these categories: 5 PRENATAL CARE AND PRETERM BIRTH