Benefits and Limitations of Prenatal Care

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Abstract
In this issue of THE JOURNAL, Kogan and colleagues1 identified trends in the patterns of prenatal care utilization in the United States from 1981 through 1995. Four measures of utilization were examined. First, the authors examined patterns based on the trimester that care began and the Institute of Medicine (IOM) Index of Adequacy of Care (Kessner Index).2 Clearly, the trimester that care began is an inadequate measure of prenatal care use because neither the total number of visits nor the number of visits relative to the length of gestation is incorporated. While the IOM Index does consider the number of visits, it has been criticized for failing to incorporate the full length of gestation in considering the adequacy of the number of visits. Second, because both these older indices had limitations, the authors also chose to examine patterns of prenatal care utilization using 2 newer measures: R-GINDEX3 and Adequacy of Prenatal Care Utilization (APNCU) Index.4,5 Both of these measures include a category of "intensive utilization" to categorize women who receive more than the recommended number of visits. Based on these newer indices, the authors report that utilization of prenatal care, especially intensive utilization, has been increasing steadily since 1981. The same relationship was not identified using the 2 older indices, with utilization just beginning to increase, only slightly, during the 1990s.