UNPLANNED PREGNANCY AS A MAJOR DETERMINANT IN INADEQUATE USE OF PRENATAL-CARE

Background. Previous reports have stressed the importance of social cl ass and education in prenatal care use, Unplanned pregnancy as a deter minant of prenatal care use has been insufficiently studied. The objec tive of this report was to assess whether unplanned pregnancy is an in dependent predictor of inadequate use of prenatal care. Methods. A 5% sample of women delivering at a hospital (409 women in the study popul ation) was selected. Data on pregnancy were obtained by personal inter view and from clinical charts, Prenatal care was considered inadequate according to the Kessner index. Relative risk (RR) and 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was applied to select the independent predictors of inadequate prenata l care use. Results. Prenatal care use was inadequate among 16.4% of t he women. Pregnancy was unplanned among 42.8% of the women. Twenty-two percent of women with an unplanned pregnancy used prenatal care inade quately, while 12% of those with planned pregnancies used prenatal car e inadequately (RR = 1.9, 95% CI = 1.2-2.9). In crude analysis, inadeq uate prenatal care use was also related to lower social class, lower e ducation level, no employment outside the home, and multiparity. After adjustment was made for other predictors that were included in a step wise logistic regression model (maternal education, social class, mate rnal occupation, parity, and pregnancy-induced hypertension), unplanne d pregnancy was a significant risk factor for inadequate use of prenat al care (odds ratio = 2.1, 95% CI = 1.2-3.7) and it was an independent predictor for a delayed first prenatal care visit and for a reduced n umber of visits. Conclusions. The results suggest that unplanned pregn ancy is a major determinant for inadequate use Of prenatal care. (C) 1 997 Academic Press.