Relationship between Pre-Natal Care and Immunization
Objective: The objective of this study was to determine the relationship between patterns of pre-natal care (PNC) in Medicaid enrolled women and subsequent preventive immunization rates among the infants of their current pregnancy.
prospective cohort study of 608 newborns delivered at the Hospital of
University of Pennsylvania. Data
was collected through medical chart review, and
primary care physician chart review.
Outcomes measure included adequate immunization at 6 months and adequate
Results: Mothers with adequate PNC were 1.47
times as likely to have their
child’s immunization up to date (C.I 0.98,2.3) p=0.06.
are effective in preventing many highly contagious and potentially deadly
childhood infectious diseases (Peter,1992).
Immunization rates among pre-school children remain below the goals
identified for the year 2000 Health Objectives for the nation (CDC, 1993).
Low immunization rates have been associated with inner-city populations
and with lack of PNC care (Cutts et al., 1992).
The objective of this study was to determine the relationship between
patterns of PNC in Medicaid enrolled women and subsequent
preventive-immunization rates among the infants of their current pregnancy.
Immunization against childhood infectious diseases is one of the most important and cost-effective public health interventions (Gergen et al., 1995; Peter, 1992). Although 95% of school age children are immunized, immunization rates for pre-school students are much lower (CDC,1993; Hinman, 1991).
It has been shown that mothers with minimum PNC are less likely to obtain up-to-date immunizations for their newborns (Cutts et al., 1992). Numerous attempts to improve access to PNC for women on Medicaid (e.g. Medicaid or community health clinics) have been only partially successful (Butz et al., 1993; Krieger, Connell and LoGerfo, 1992). Our present healthcare system has not addressed the maternal factors that contribute to lack of immunization and this may explain the lower compliance (NVAC,1991; Roghmann & Haggerty, 1972). Understanding the necessity of childhood immunizations has taken on even more importance since September 11th , 2001 because of the threat of biological warfare (e.g., diphtheria) in the U.S. This study was conducted to identify those maternal variables associated with higher immunization rates for newborns.
enrolled in Medicaid who obtain adequate PNC will subsequently have up-to-date
immunizations for their newborns. Adequate
pre-natal care is defined as 8 or more pre-natal visits with the first pre-natal
visit in the first trimester.
Review Board approval was obtained along with patient consent.
A prospective cohort study was conducted of 608 newborns delivered at the
Hospital of the University of Pennsylvania in 2000.
Inclusion criteria were: (a) enrollment in Medicaid, (b) greater than 34
week gestation, (c) greater than 2 Kg birth weight, and (d) less than 10 day
nursery stay. Information on the
independent variables of PNC (Table I) was determined by mother’s post partum
information and medical record review. Data
collection included medical record review and primary care chart review. STATA was used for statistical analysis of data.
Outcome information for up to date immunizations (Table I) at 6 months of
age included: 1 HepB, 2 Hib, 2 DTAP, and 2 IPV and was obtained through primary
care physician chart review.
Table I. Outcome Measures for Adequate Pre-Natal Care and Up to Date Immunizations
423 of 608 infants born during 2000 were followed for this study. The reasons for 185 infants not being followed included: (a) patient relocation, (b) incorrect phone numbers, and (c) refusal to comply with requests. Table 2 shows that the mean age and education of the mothers was 22 years old and 11 years respectively and 63% were employed before pregnancy. Figure 1 shows that adequate PNC was found in 52% of the population and up-to-date 6-month immunizations, as defined by American Committee of Immunization Practices, was 63%. Mothers with adequate PNC were 1.47 times more likely to have their child’s immunization up-to-date than were those without adequate PNC (C.I. 0.98,2.3) p=0.06. Significant variables for adequate PNC were completing high school education and pre-pregnancy employment. (p<0.0001) (Table 3)
Table 2: Maternal Characteristics (N=423)
Figure 1. Relationship of
Pre-natal Care to Immunization.
Table 3. Maternal Characteristics and Adequate Pre-natal Care
The results of this study strongly suggest that adequate PNC affects the immunization rates of children. Adequate PNC was influenced by high school completion and pre-pregnancy employment. The mother’s age, race, and time of first pre-natal visit were not significant variables for immunization.
findings suggest that identification of newborns at risk for non-immunization
can be determined by identifying mothers without a high school degree and
mothers who were unemployed prior to becoming pregnant.
The limitations of study are:
a) homogenous populations – 96.9% African American, and (b) convenient
sample size due to chart and physician availability and transient residence of
mothers. Future research should include the identification of other variables
such as transportation and the number of children in the family which might be
used to further predict newborns at risk for non-immunization.
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I wish to acknowledge the assistance of Dr. E. Alessandrin,
Emergency Department, Children’s Hospital of Philadelphia, for allowing me to
conduct this study and giving me access to the database and to Dr. Maryanne
McGuckin, University of Pennsylvania School of Medicine for her assistance with
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