Missouri Resident Prenatal Profile

 

Care Began First Trimester

Resident live births in which the mother started prenatal care in her first trimester of pregnancy. The rate is per 100 resident live births with known prenatal care status.

Late Care (2nd/3rd Trimester)

Resident live births in which the mother started prenatal care after the end of the third month of pregnancy. The rate is per 100 resident live births with known prenatal care status.

No Prenatal Care

Resident live births in which the mother did not receive prenatal care. The rate is per 100 resident live births with known prenatal care status.

Prenatal Care Adequacy (Missouri Index): Inadequate

Live births with fewer than five prenatal care visits for pregnancies less than 37 weeks gestation, fewer than eight visits for pregnancies 37 or more weeks, or prenatal care began after the first four months of pregnancy. Before 1994 records with unknown month prenatal care began or unknown prenatal visits were excluded. Beginning in 1994, if adequacy of prenatal care could be determined, even if month care began or number of visits were unknown, then these records were included. (This is referred to as the Missouri Index of Adequacy of Prenatal Care Utilization.) The rate for this number is per 100 live births where adequacy of prenatal care using the Missouri Index was known.

Both the Missouri and Kotelchuck indices use the American College of Obstetricians and Gynecologists (ACOG) prenatal care standards for uncomplicated pregnancies as a guide to determine if a mother receives an adequate or inadequate amount of prenatal care during her pregnancy. Both assume inadequate care if a mother starts prenatal care after the fourth month or receives no care. The Kotelchuck index (see below) uses a complex formula to calculate an expected number of visits based on the ACOG guidelines adjusted for timing of first month of prenatal care and exact gestational age at delivery. The Missouri index is more simplified and has just two categories. The Kotelchuck index has been recognized nationally since the mid 1990s. The Missouri index has been used in the Missouri annual Vital Statistics report since 1979. Those favoring the Missouri index feel the quality of the data does not justify the precision required from the Kotelchuck index. Rates of inadequate prenatal care generally run 15 to 20 percent higher using the Missouri index. Nearly all of those classified as inadequate in the Missouri index are also classified as inadequate in the Kotelchuck, but some classified as inadequate in the Missouri index are classified as intermediate in the Kotelchuck index.

Prenatal Care Adequacy (Kotelchuck Index): Inadequate

The Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU), uses two crucial elements obtained from birth certificate data-when prenatal care began (initiation) and the number of prenatal visits from when prenatal care began until delivery (received services). The Kotelchuck index classifies the adequacy of initiation as follows:

with the underlying assumption that the earlier prenatal care begins the better. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery.

A ratio of observed to expected visits is calculated and grouped into four categories:

The final Kotelchuck index measure combines these two dimensions into a single summary score. The profiles define adequate prenatal care as a score of 80% or greater on the Kotelchuck Index, or the sum of the Adequate and Adequate Plus categories. The Kotelchuck Index does not measure the quality of prenatal care. It also depends on the accuracy of the patient or health care provider's recall of the timing of the first visit and the number of subsequent visits. The Kotelchuck Index uses recommendations for low-risk pregnancies, and may not measure the adequacy of care for high-risk women. The Kotelchuck Index is preferable to other indices because it includes a category for women who receive more than the recommended amount of care (adequate plus, or intensive utilization).

The rate of this number is per 100 live births where prenatal care adequacy using the Kotelchuck Index was known.

Prenatal Medicaid

Number of resident live births to mothers participating in Medicaid during their pregnancy. The rate is per 100 resident live births with known Medicaid status. Medicaid status is acquired from the birth certificate.

Prenatal WIC

Number of resident live births to mothers participating in WIC during their pregnancy. The rate is per 100 resident live births with known WIC status. WIC status is acquired from the birth certificate.

Prenatal Food Stamps

Number of resident live births to mother participating in Food Stamps during their pregnancy. The rate is per 100 resident live births with known Food Stamp status. Food Stamp status is acquired from the birth certificate.

Weight Gain less than 15 Pounds – Singleton

Full term resident singleton live births to females gaining less than 15 pounds or losing weight during pregnancy.  The rate is per 100 resident full term singleton live births with mother’s weight gain or loss known.

Weight Gain greater than or equal to 45 Pounds – Term Singleton

Full term resident singleton live births to females gaining 45 or more pounds during pregnancy.  The rate is per 100 resident full term singleton live births with mother’s weight gain or loss known.

Gestational Diabetes

The number of women who has gestational diabetes during pregnancy. Starting in 2010, there are two types of diabetes that were recorded on the birth certificate: gestational and pre-pregnancy. Pre-pregnancy is diabetes that the woman had before becoming pregnancy. Gestational diabetes is brought on by the pregnancy and the woman did not have it before becoming pregnant. If diabetes was not recorded on the birth certificate, then the woman is counted as not having diabetes. The rate is per 100 resident live births.

Pre-Pregnancy Diabetes

The number of women who has pre-pregnancy diabetes during pregnancy. Starting in 2010, there are two types of diabetes that were recorded on the birth certificate: gestational and pre-pregnancy. Pre-pregnancy is diabetes that the woman had before becoming pregnancy. Gestational diabetes is brought on by the pregnancy and the woman did not have it before becoming pregnant. If diabetes was not recorded on the birth certificate, then the woman is counted as not having diabetes. The rate is per 100 resident live births.

Mother Smoked During Pregnancy

Resident live births to mothers who smoked during pregnancy. The rate is per 100 resident live births with known smoking status.