Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995

Objective: Although poor prenatal care is detrimental to maternal and infan t health, few studies have assessed the adequacy of prenatal care among wom en with psychiatric diagnoses. This investigation examined the association between chart-recorded psychiatric and substance use diagnoses at the time of delivery and adequacy of prenatal care among all women delivering babies in California hospitals during 1994 and 1995. Methods: The authors underto ok an archival analysis of data from the California Health Information for Policy Project (CHIPP), which consists of linked hospital discharge and bir th certificate data for 1,094,178 deliveries in 1994 and 1995, The associat ions between International Classification of Diseases, 9th Revision, Clinic al Modification psychiatric and substance abuse diagnoses and level of pren atal care were examined. Logistic regression analyses were conducted to ass ess the association between maternal diagnostic category and inadequate pre natal care while controlling fur payment source, age, education, race, mari tal status, and parity (previous births). Results: Women who received psych iatric and substance use diagnoses demonstrated significantly increased ris k of inadequate prenatal care compared with women without those diagnoses. Conclusions: Psychiatric diagnoses were associated: with an increased risk of inadequate prenatal care; the association between psychiatric and substa nce use diagnoses and poor prenatal care persisted even after the analysis controlled for known risk factors. Future investigations will need to eluci date the processes of prenatal care for women with psychiatric disorders so that preventive interventions can be developed.