Pattern of prenatal care and infant immunization status in a comprehensive adolescent-oriented maternity program
C. Stevens-Simon, L. S. Kelly and D. Singer
Department of Pediatrics, University of Colorado Health Science Center, Denver, USA.
OBJECTIVE: To examine the relationship between patterns of prenatal care
utilization and the subsequent pattern of preventive infant health care
utilization among patients in a comprehensive, multidisciplinary,
adolescent-oriented maternity program. METHODS: We hypothesized that the
mothers of incompletely immunized 8-month-olds were less compliant with
their own prenatal care appointments than were mothers of fully immunized
8-month-olds. We retrospectively reviewed the medical records of 150
consecutively delivered infants and their adolescent mothers. Data
concerning the pattern of prenatal and postnatal use of preventive health
care services and potentially confounding maternal characteristics were
collected. RESULTS: Of the 150 infants aged 8 months, 22 (14.7%) were
incompletely immunized. Mothers of completely and incompletely immunized
infants did not differ in age, school enrollment status, or compliance with
prenatal appointments. However, the latter group initiated prenatal care
later, obtained fewer prenatal visits, returned later for postpartum care,
and were more likely to be black and to report inadequate family support
after delivery. Three of the 5 characteristics entered a logistic
regression function that predicted the risk of incomplete immunizations at
8 months of age: third-trimester initiation of prenatal care (odds ratio,
4.05; 95% confidence interval, 1.19-13.7), inadequate family support (odds
ratio, 3.42; 95% confidence interval, 1.17-10.0), and black race (odds
ratio, 3.14; 95% confidence interval, 1.19-8.69). The total model chi 2 was
15.8 (P < .001). CONCLUSIONS: Among patients in a comprehensive
adolescent-oriented maternity program, the timing of the first prenatal
visit helps to identify infants who are at increased risk for incomplete
primary immunization status. Our findings favor preferential allocation of
scarce, costly outreach services to infants born to adolescent mothers who
enter prenatal care during the third trimester.
