Factors Associated with Prenatal Care Among Women in MIRIAD Study

Prenatal care allows not only for the opportunity to provide obstetrical care to women during pregnancy, but also to screen women at risk for other health conditions or complications of pregnancy, and identify medical and psychological risk factors. This study sought to evaluate factors associated with receiving and not receiving prenatal care among women who presented to labor and delivery without HIV status documentation. This was a prospective multicenter study, done as a secondary analysis of the Mother Infant Rapid Intervention at Delivery (MIRIAD) study. The MIRIAD study was conducted between 2001 and 2005 under sponsorship of the CDC in 18 hospitals around six US cities (Atlanta, Baton Rouge, Chicago, Miami, New Orleans, New York City). Women were eligible is they had undocumented HIV status during their current pregnancy, and had either presented to prenatal care after 34 weeks or presented in labor or with an indication for urgent delivery and were ≥ 24 weeks. These women were consented on labor and delivery, and then a face-to-face interview was conducted within 1 day of delivery.
The interview included questions regarding demographics, psychosocial characteristics (social support, quality of life, attitudes towards current pregnancy, recent incarceration), health behavior (cigarette, alcohol and drug use) and perceived health status. Prenatal care was defined as subject recall of one or more visits during the current pregnancy. For the MIRIAD study, 9,233 women were approached, 7,898 were enrolled, and 52 were identified as HIV positive. This study reviewed the 52 HIV positive, plus 3 HIV negative controls for every HIV positive woman. They also added an additional 500 HIV negative controls to lend power, for a total of 667 peripartum women.
Of these 667 women, the mean age was 26 years, the majority were US born, 61.9% were African American, 33% Hispanic, slightly over 50% were high school graduates. At least half had a monthly income of $1,000 or less. Women who did not receive prenatal care were more likely to care for children (AOR = 0.55) or have children living with someone else (AOR=0.47). They also were more likely to use alcohol during the current pregnancy (AOR=0.46) and report being unhappy or not wanting the current pregnancy (AOR= 0.53). Women who received Medicaid (AOR3.22) and lived with a partner (AOR=1.77) were more likely to receive PNC. Those with higher levels of perceived social support (AOR-1.53), and with better self reported health status (AOR=1.3) were also more likely to report PNC.
Over one quarter of women with undocumented HIV status reported receiving no prenatal care. These women were more likely to be poor minority women, care for children or have children living with someone else, use alcohol, or report not wanting or being unhappy with the pregnancy. Limitations of this study include reliance on patient report of prenatal care. This study was a secondary analysis of a small subset of patients, in areas with higher prevalence of HIV infection in pregnant women, and therefore may lack generalizability.
The authors concluded that the findings of this study may allow for identification of missed opportunities for introduction of prenatal care, including at pediatric visits and from providers who offer pregnancy tests. Medicaid may provide an important safety net to enhance prenatal care.
--Summarized by Carey Eppes, MD

Potter, J., Pereyra, M., Lampe, M., Rivero, Y., et al. Factors Associated with Prental Care Use AOmng Peripartum Women in the Mother-Infancts Rapid Intervention at Delivery Study. JOGNN 2009; Vol 38, Issue 5. 534-43.

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