PATTERN OF PRENATAL-CARE AND INFANT IMMUNIZATION STATUS IN A COMPREHENSIVE ADOLESCENT-ORIENTED MATERNITY PROGRAM

Objective: To examine the relationship between patterns of prenatal ca re 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 record s of 150 consecutively delivered infants and their adolescent mothers. Data concerning the pattern of prenatal and postnatal use of preventi ve health care services and potentially confounding maternal character istics were collected. Results: Of the 150 infants aged 8 months, 22 ( 14.7%) were incompletely immunized. Mothers of completely and incomple tely 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, returne d later for postpartum care, and were more likely to be black and to r eport inadequate family support after dt lively. Three of the 5 charac teristics entered a logistic regression function that predicted the ri sk of incomplete immunizations at 8 months of age: third-trimester ini tiation 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%;, confide nce interval, 1.19-8.69). The total model chi(2) was 15.8 (P<.001). Co nclusions: Among patients in a comprehensive adolescent-oriented mater nity 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 pren atal care during the third trimester.