PRENATAL-CARE AND BIRTH OUTCOMES OF A COHORT OF HIV-INFECTED WOMEN

Adequate prenatal care has been linked to improved birth outcomes in g eneral populations but has not been assessed in HIV-infected women. We examined longitudinal claims files and vital statistics records for w omen in the New York State Medicaid HIV/AIDS data base delivering a si ngleton from 1985 through 1990. Adequacy of the self-reported number o f prenatal visits was assessed by the Kessner index. In logistics mode ls, we estimated the association of prenatal care, illicit drug use, a nd other maternal characteristics with three outcomes: low birth weigh t, preterm birth, and small-for-gestational-age. Of 2,254 singletons d elivered by this HIV-infected cohort, 28% were low birth weight, 23% w ere preterm birth, and 20% were small for gestational age. Two-thirds had inadequate prenatal care. Non-drug users had 57 and 26% lower adju sted odds of low birth weight and preterm delivery than drug users. Th e adjusted odds of low birth weight and preterm birth for women with a n adequate number of prenatal visits were, respectively, 48 and 21% lo wer than for women with inadequate care. Adequate prenatal care was al so associated with a 43% reduction in the odds of small-for-gestationa l-age. An adequate number of prenatal visits by women in this HIV coho rt was associated with a significant reduction in all three adverse bi rth outcomes, but most had inadequate prenatal care. These data suppor t strengthening efforts to bring pregnant, HIV-infected women into car e.