Journal of Community Health

, Volume 27, Issue 1, pp 15–31

The Influence of Proximity of Prenatal Services on Small-for-Gestational-Age Birth

  • Katherine E. Heck
  • Kenneth C. Schoendorf
  • Gilberto F. Chavez


Some studies suggest that prenatal services may decrease the risk of poor fetal growth for full-term infants, but have not examined the influence of the availability of community health and social services. The availability of prenatal services may have a stronger effect among women already at high risk of a small-for-gestational-age (SGA) birth. Singleton full-term (≥37 weeks gestation) California births for 1997–98 (n = 744,736) were geocoded to maternal Census tract of residence. Women were placed into one of three demographic risk groups utilizing combinations of maternal age, marital status, parity, and education. SGA was defined as birthweight less than the 10th percentile for gestational age. Locations of WIC sites, prenatal care providers, and perinatal outreach programs were geocoded. Multilevel logistic regression was used to model the influence of community health care services on SGA, adjusting for additional maternal and community factors. There was no association between SGA and community services available for either high- or low-risk women, in either unadjusted or adjusted models. The addition of maternal prenatal care utilization to models did not change the results. Maternal residence near prenatal services was not associated with SGA, regardless of demographic risk; other community factors may warrant consideration.

small for gestational age prenatal care multilevel models 


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  1. 1.
    Shapiro S, Unger J. Weight at birth and its effect on survival of the newborn in the United States, early 1950. Vital Stats (special report). Vol. 39, no. 1. National Office of Vital Statistics, PHS. 1954.Google Scholar
  2. 2.
    Schlesinger ER, Allaway NC. The combined effect of birth weight and length of gestation on neonatal mortality among single premature births. Pediatrics 1955; 15: 698–704.PubMedGoogle Scholar
  3. 3.
    Kiely JL, Brett KM, Yu S, Rowley DL. Low birth weight and intrauterine growth retardation. In: Wilcox LS and Marks JS, ed. From data to action: CDC's public health surveillance for women, infants, and children. US Department of Health & Human Services, pp 185–202.Google Scholar
  4. 4.
    Alexander GR, Korenbrot CC. The role of prenatal care in preventing low birth weight. The Future of Children 1995; 5: 103–120.Google Scholar
  5. 5.
    Institute of Medicine. Preventing low birthweight. Washington, DC: National Academy Press, 1985.Google Scholar
  6. 6.
    Kramer MS, Platt R, Yang H, et al. Are all growth-restricted newborns created equal(ly)? Pediatrics 1999; 103: 599–602.PubMedGoogle Scholar
  7. 7.
    Collins JW, Martin CR. Relation of traditional riskfactors to intrauterine growth retardation among United States-born and foreign-born Mexican Americans in Chicago. Ethn Dis 1998; 8: 21–5.Google Scholar
  8. 8.
    O'Campo P, Xue X, Wang MC, Caughy M. Neighborhood riskfactors for low birthweight in Baltimore: a multilevel analysis. Am J Public Health 1997; 87: 1113–8.PubMedGoogle Scholar
  9. 9.
    Gorman BK. Racial and ethnic variation in low birthweight in the United States: individual and contextual determinants. Health Place 1999; 5: 195–207.PubMedGoogle Scholar
  10. 10.
    Robert SA. Socioeconomic position and health: the independent contribution of community socioeconomic context. Annu Rev Sociol 1999; 25: 489–516.Google Scholar
  11. 11.
    Roberts RO, Yawn BP, Wickes SL, Field CS, Garretson M, Jacobsen SJ. Barriers to prenatal care: factors associated with late initiation of care in a middle-class midwestern community. J Fam Pract 1998; 47: 53–61.PubMedGoogle Scholar
  12. 12.
    Harvey SM, Faber KS. Obstacles to prenatal care following implementation of a communitybased program to reduce financial barriers. Fam Plann Perspect 1993; 25: 32–6.PubMedGoogle Scholar
  13. 13.
    Turner BJ, Newschaffer CJ, Cocroft J, Fanning TR, Marcus S, Hauck WW. Improved birth outcomes among HIV-infected women with enhanced Medicaid prenatal care. Am J Public Health 2000; 90: 85–91.PubMedGoogle Scholar
  14. 14.
    Scholl TO, Miller LK, Salmon RW, Cofsky MC, Shearer J. Prenatal care adequacy and the outcome of adolescent pregnancy: effects on weight gain, preterm delivery, and birth weight. Obstet Gynecol 1987; 69: 312–6.PubMedGoogle Scholar
  15. 15.
    Wilson AL, Munson DP, Schubot DB, Leonardson G, Stevens DC. Does prenatal care decrease the incidence and cost of neonatal intensive care admissions? Am J Perinatol 1992; 9: 281–4.PubMedGoogle Scholar
  16. 16.
    Devaney B, Bilheimer L, Schore J. Medicaid costs and birth outcomes: the effects of prenatal WIC participation and the use of prenatal care. J Policy Anal Manage 1992; 11:573–92.PubMedGoogle Scholar
  17. 17.
    Poma PA. Effect of prenatal care on infant mortality rates according to birth-death certificate files. J Natl Med Assoc 1999; 91: 515–20.PubMedGoogle Scholar
  18. 18.
    Buescher PA, Larson LC, Nelson MD, Lenihan AJ. Prenatal WIC participation can reduce low birth weight and newborn medical costs: a cost-benefit analysis of WIC participation in North Carolina. J Am Diet Assoc 1993; 93: 163–6.PubMedGoogle Scholar
  19. 19.
    McDermott JM, Drews CD, Adams MM, Hill HA, Berg CJ, McCarthy BJ. Does inadequate prenatal care contribute to growth retardation among second-born African-American babies? Am J Epidemiol 1999; 150: 706–13.PubMedGoogle Scholar
  20. 20.
    Raine T, Powell S, Krohn MA. The riskof repeating low birth weight and the role of prenatal care. Obstet Gynecol 1994; 84: 485–9.PubMedGoogle Scholar
  21. 21.
    Walker DS, Koniak-Griffin D. Evaluation of a reduced-frequency prenatal visit schedule for lowriskwomen at a free-standing birthing center. J Nurse Midwifery 1997; 42: 295–303.PubMedGoogle Scholar
  22. 22.
    Herman AA, Berendes HW, Yu KF, Cooper LC, Overpeck MD, Rhoads G, Maxwell JP, Kinney BA, Koslowe PA, Coates DL. Evaluation of the effectiveness of a community-based enriched model prenatal intervention project in the District of Columbia. Health Serv Res 1996; 31: 609–21.PubMedGoogle Scholar
  23. 23.
    Huntington J, Connell FA. For every dollar spent—the cost-savings argument for prenatal care. N Engl J Med 1994; 331:1303–7.PubMedGoogle Scholar
  24. 24.
    Fiscella K. Does prenatal care improve birth outcomes? A critical review. Obstet Gynecol 1995; 85:468–79.PubMedGoogle Scholar
  25. 25.
    Fink A, Yano EM, Goya D. Prenatal programs: what the literature reveals. Obstet Gynecol 1992; 80:867–72.PubMedGoogle Scholar
  26. 26.
    Shah BV, Barnwell BG, Bieler GS. SUDAAN User's manual: Software for analysis of correlated data, release 6.40. Research Triangle Institute: Research Triangle Park, NC. 1995.Google Scholar
  27. 27.
    Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87:163–8.PubMedGoogle Scholar
  28. 28.
    Kleinman JC, Kessel SS. Racial differences in low birth weight: Trends and riskfactors. New Engl J Med 1987;317:749–53.PubMedGoogle Scholar
  29. 29.
    Kleinman JC, Fingerhut LA, Prager K. Differences in infant mortality by race, nativity status, and other maternal characteristics. Am J Diseases Children 1991; 145:194–99.Google Scholar
  30. 30.
    LaVeist TA. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q 1993; 71: 41–64.PubMedGoogle Scholar
  31. 31.
    Fuentes-Afflick E, Hessol NA, Perez-Stable EJ. Testing the epidemiologic paradox of low birth weight in Latinos. Arch Pediatr Adolesc Med 1999; 153:147–53.PubMedGoogle Scholar

Copyright information

© Human Sciences Press, Inc. 2002

Authors and Affiliations

  • Katherine E. Heck
    • 1
  • Kenneth C. Schoendorf
    • 2
  • Gilberto F. Chavez
    • 3
  1. 1.California Department of Health ServicesNational Center for Health Statistics. Maternal and Child Health BranchSacramento
  2. 2.Infant and Child Health Studies BranchNational Center for Health StatisticsUSA
  3. 3.California Department of Health ServicesMaternal and Child Health BranchSacramento

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