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Major successes in prenatal care have been related more to preserving maternal health than improving fetal outcomes

Infant mortality rates in the United States continue to be higher than those in most industrialized countries. Unfortunately, current prenatal interventions appear to have limited potential to reduce the prevalence of the major fetal problems that increase the risk of infant death: prematurity, intrauterine growth restriction (IUGR), and birth defects.

Evidence suggests that these conditions are initiated by events early in pregnancy, and prenatal interventions may not occur early enough in pregnancy to affect them. More attention should be focused on improving women's health care and health habits, for the main success of prenatal care has been in the preservation of women's health, according to participants at a conference that was supported in part by the Agency for Healthcare Research and Quality (HS09528).

Participants at the 1997 conference examined the effects of prenatal care on both mother and child. They concluded that prenatal targets offering some promise for reducing premature births include antibiotic treatment of bacterial vaginosis (a risk factor for preterm delivery) during pregnancy, reducing maternal tobacco use, supplementing deficient maternal iron stores, and reducing maternal stress.

Providing routine prenatal care, as well as specific interventions such as enhanced nutrition, use of drugs to inhibit labor, and the early identification of labor through home uterine monitoring, have not been shown to be effective in reducing the incidence of low birthweight infants. In fact, the major arguments for the cost-effectiveness of prenatal care have focused on the benefits of prenatal care in preventing low birthweight and prematurity, but evidence is lacking to substantiate these arguments. Nevertheless, approaches ranging from use of perinatal and neonatal care units to early preschool education can mitigate the impact of prematurity (congenital malformations, reactive airway disease, and neurodevelopmental disorders), note Marie C. McCormick, M.D., Sc.D., and Joanna E. Siegel, Sc.D., of the Harvard School of Public Health.

See "Recent evidence on the effectiveness of prenatal care," by Drs. McCormick and Siegel, in the November 2001 Ambulatory Pediatrics 1(6), pp. 321-325.

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