Health Policy and Planning Advance Access originally published online on March 12, 2009
Health Policy and Planning 2009 24(3):175-188; doi:10.1093/heapol/czp005
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Prenatal care effectiveness and utilization in Brazil
1 MPH, PhD, Assistant Professor, Dept of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.
2 MD, Professor, Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, IA, USA.
3 MD, PhD, Professor, ECLAMC (Latin American Collaborative Study of Congenital Malformations) at CEMIC, Buenos Aires, Argentina, and ECLAMC at Instituto Oswaldo Cruz, Rio de Janeiro, Brazil.
4 PhD, Professor, ECLAMC at Imbice, La Plata, Argentina.
5 PhD, Professor, Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA.
* Corresponding author. Assistant Professor, Dept of Health Management and Policy, University of Iowa, E204, GH, Iowa City, IA 52242, USA. Tel: +1–319–384–5133. Fax: +1–319–384–5125. E-mail: george-wehby{at}uiowa.edu
The impact of prenatal care use on birth outcomes has been understudied in South American countries. This study assessed the effects of various measures of prenatal care use on birth weight (BW) and gestational age outcomes using samples of infants born without and with common birth defects from Brazil, and evaluated the demand for prenatal care. Prenatal visits improved BW in the group without birth defects through increasing both fetal growth rate and gestational age, but prenatal care visits had an insignificant effect on BW in the group with birth defects when adjusting for gestational age. Prenatal care delay had no effects on BW in both infant groups but increased preterm birth risk in the group without birth defects. Inadequate care versus intermediate care also increased LBW risk in the group without birth effects. Quantile regression analyses revealed that prenatal care visits had larger effects at low compared with high BW quantiles. Several other prenatal factors and covariates such as multivitamin use and number of previous live births had significant effects on the studied outcomes. The number of prenatal care visits was significantly affected by several maternal health and fertility indicators. Significant geographic differences in utilization were observed as well. The study suggests that more frequent use of prenatal care can increase BW significantly in Brazil, especially among pregnancies that are uncomplicated with birth defects but that are at high risk for low birth weight. Further research is needed to understand the effects of prenatal care use for pregnancies that are complicated with birth defects.
Key Words: Prenatal care, low birth weight, preterm birth, quantile regression, birth outcomes, infant health, Brazil
Accepted for publication 6 January 2009.