Adequacy of prenatal care and prescription of zidovudine to prevent perinatal HIV transmission

In 1994, data were published on the effectiveness of zidovudine in pre vent ing perinatal transmission of HIV infection. Using data from surveillance p rojects in San Antonio, Dallas, and Houston, Texas, U.S.A., we linked recor ds of children born from 1987 through 1996 with records of their HIV-infect ed mothers. Prenatal care was measured by Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index. We examined the association between adequa cy of prenatal care and four measures of zidovudine prescription: prenatal, intrapartum, neonatal, and the complete regimen. Inclusion criteria was th at the mother's HIV infection was diagnosed before a live birth; 221 mother -infant pairs were included in the analysis. Overall. 68% received inadequa te or no prenatal care. Over time, the proportion of mother-infant pairs wi th adequate prenatal care doubled (24%-48%; relative risk [RR], 2.0; 95% co nfidence interval [CI], 1.3-3.0), and the proportion prescribed prenatal zi dovudine tripled (20%-67%; RR, 3.3; 95% CI, 2.4-4.9). In logistic regressio n, APNCU (adjusted odds ratio [aOR], 2.6, 95% CI, 1.1-6.2) and time period (aOR, 19.9; 95% CI, 8.1-48.7) were associated with prenatal prescription of zidovudine. The benefits of prenatal care, including HIV testing and zidov udine treatment, underscore the urgent need to improve access to and use of prenatal care services.