Alpha 2.0
Login Register
» Articles » PMID: 8092364

An Evaluation of the Kessner Adequacy of Prenatal Care Index and a Proposed Adequacy of Prenatal Care Utilization Index

Overview
Journal Am J Public Health
Specialty Public Health
Date 1994 Sep 1
PMID 8092364
Citations 415
Authors
M Kotelchuck
Affiliations
Soon will be listed here.
Abstract

Objectives: The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination.

Methods: Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation.

Results: The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming.

Conclusions: The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.

Citing Articles

Are racial and ethnic disparities in brachial plexus birth injuries explained by known risk factors?.

Manske M, Wilson M, Wise B, Hedriana H, Melnikow J, Tancredi D J Perinatol. 2025; .

PMID: 40089579 DOI: 10.1038/s41372-025-02239-8.

Adequate Prenatal Care and Maternal Morbidity Among Birthing People with Preexisting Comorbidities.

Chaves Cerdas L Matern Child Health J. 2025; .

PMID: 39994104 DOI: 10.1007/s10995-025-04069-8.

Disparities in prenatal care utilization among racial/ethnic and nativity subgroups in the United States.

Sugy C, McElfish P, Brown C Prev Med. 2025; 192:108238.

PMID: 39889834 PMC: 11845284. DOI: 10.1016/j.ypmed.2025.108238.

Prenatal syphilis and adverse pregnancy outcomes in women with HIV receiving ART in Brazil: a population-based study.

Castilho J, Fonseca F, Kim A, Jalil E, Tu S, Beber A Lancet Reg Health Am. 2025; 39():100894.

PMID: 39839683 PMC: 11747186. DOI: 10.1016/j.lana.2024.100894.

What Influences Postpartum Depressive Symptoms? The role of Social Determinants of Health, Race-Based Discrimination and Stressful Life Experiences.

Ringenary H, Froelich J, Njoroge W, Gerstein E Matern Child Health J. 2025; 29(2):183-193.

PMID: 39826084 DOI: 10.1007/s10995-025-04055-0.

References
1.
Gortmaker S . The effects of prenatal care upon the health of the newborn. Am J Public Health. 1979; 69(7):653-60. PMC: 1619097. DOI: 10.2105/ajph.69.7.653. View
2.
Quick J, Greenlick M, Roghmann K . Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis. Am J Public Health. 1981; 71(4):381-90. PMC: 1619678. DOI: 10.2105/ajph.71.4.381. View
3.
Placek P . The 1980 National Natality Survey and National Fetal Mortality Survey--methods used and PHS agency participation. Public Health Rep. 1984; 99(2):111-6. PMC: 1424549. View
4.
Showstack J, Budetti P, Minkler D . Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation. Am J Public Health. 1984; 74(9):1003-8. PMC: 1651784. DOI: 10.2105/ajph.74.9.1003. View
5.
Forrest J, Singh S . Timing of prenatal care in the United States: how accurate are our measurements?. Health Serv Res. 1987; 22(2):235-53. PMC: 1065433. View