Potentially avoidable maternity complications: an indicator of access to prenatal and primary care during pregnancy

OBJECTIVE: We identified Potentially Avoidable Maternity Complications (PAMCs). Used with hospital discharge data, PAMCs may indicate lack of prenatal care access. METHODS: A research team of two obstetrician/gynecologists and three health services researchers developed the PAMC indicator, which was verified by external review. AIM 1 used the National Maternal and Infant Health Survey, with prenatal care information and 8,661 pregnancy hospitalizations, to examine associations between prenatal care, risk factors, and PAMCs. AIM 2 used the 1997 Nationwide Inpatient Sample (NIS), with 895,259 pregnancy-related hospitalizations, to examine PAMC risks for groups likely to have prenatal care access problems. RESULTS: In AIM 1, adequate prenatal care reduced PAMC risks by 57% (p < .01). Compared to nonsmokers, the odds of a PAMC for smokers were 86% higher (p < .01). Cocaine use increased PAMC risk notably (odds ratio 3.35, p < .0001). In the multivariate analyses of AIM 2, African Americans, the uninsured, and Medicaid beneficiaries had high PAMC risks (all p < .0001). CONCLUSIONS: Findings suggest adequate prenatal care may reduce PAMC risks. Results for groups with less prenatal care access were consistent with previous research using less refined indicators, such as low birth weight. PAMCs improve on earlier measures, and readily permit adjustments for mothers' ages and comorbidities.