UTILIZATION OF PRENATAL SERVICES AND BIRTH OUTCOMES - A COMMUNITY-BASED STUDY IN ISRAEL

The purpose of this paper was to assess several measures of utilisatio n of prenatal care as predictors of birth outcome in a community where the availability and quality of services were equal for all pregnant women. A case-control study was conducted in a small community in Isra el, comparing 189 women whose pregnancy resulted in an unfavourable ou tcome (perinatal mortality, preterm birth and low birthweight at term) with 384 women, matched by birth order, who had a Live, full-term inf ant weighing 2500 g or more. In a multivariable analysis, adjusting fo r pregnancy complications, maternal age, parity and socio-economic dis advantage, gestational age at initiation of prenatal care was not an i ndependent predictor of unfavourable outcome; neither was lower than t he recommended number of visits for the period under care. However, a higher than expected number of visits was associated with unfavourable outcome [odds ratio (OR)=6.10, 95% CI 2.09-17.78], as was non-complia nce with medical recommendations [OR=2.02, 95% CI 1.24-3.29. The conte xt of prenatal care delivery, as well as the process of care and compl iance with recommendations, should be assessed in order to determine t he impact of prenatal care on birth outcomes.