Original Article

Relationship between Perceived Quality of Prenatal Care and Maternal/Infant Health Outcomes

Authors: Annie Thai, BA, Katherine M. Johnson, PhD


Objectives: Studies have shown that quality of care affects patient health outcomes and well-being. In this study, we examine the relationship between perceived quality of prenatal care, birth outcomes, and postpartum depression (PPD).

Methods: We use data from the third wave of the Listening to Mothers dataset (2013). After removing missing data, the analytic sample size included 2168 women. Through linear and logistic regression analyses, we test the following hypotheses: higher perceived quality of prenatal care will have a positive association with a likelihood of vaginal delivery and normal birth weight outcomes, and a negative association with a likelihood of preterm birth; and higher perceived quality of prenatal care will have a negative association with a likelihood of PPD risk.

Results: Women who perceived higher quality of prenatal care were significantly less likely to have a preterm birth relative to women who reported lower quality care. Women who reported (any) medical jargon during their prenatal visits were less likely to have a normal birth weight baby. Women who reported provider use of medical jargon, lower perceived quality of interaction with a prenatal care provider, and lower perceived quality of US maternity care in general were more likely to be at risk for PPD.

Conclusions: Negative prenatal care experiences may exacerbate adverse patient outcomes. Positive prenatal care experiences may buffer/improve adverse outcomes. Quality of care measures were most consistently predictive of PPD outcomes. Providers should focus on improving the quality of prenatal care as one of the means to improve maternal and infant health and well-being.
Posted in: Obstetrics and Gynecology63

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1. Moos MK. Prenatal care: limitations and opportunities. J Obstet Gynecol Neonatal Nurs 2006;35:278–285.
2. American Academy of Pediatrics Committee on Fetus and Newborn and American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Guidelines for Perinatal Care, 8th Edition. Itasca, IL: American Academy of Pediatrics; 2017.
3. Carter EB, Temming LA, Akin J, et al. Group prenatal care compared with traditional prenatal care: a systematic review and meta-analysis. Obstet Gynecol 2016;128:551–561.
4. Krans EE, Davis MM. Preventing low birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care. Am J Obstet Gynecol 2012;206: 398–403.
5. Sword W, Heaman M, Brooks S, et al. Women’s and care providers’ perspectives of quality prenatal care: a qualitative descriptive study. BMC Pregnancy Childbirth 2012;12:29.
6. Riedl D, Schussler G. The influence of doctor-patient communication on health outcomes: a systematic review/der einfluss der arzt-patient-beziehung auf den gesundheitszustand: eine systematische ubersicht. Z Psychosom Med Psychother 2017;63:131–150.
7. Aiarzaguena JM, Grandes G, Gaminde I, et al. A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychol Med 2007;37:283–294.
8. Clark NM, Gong M, Schork MA, et al. Long-term effects of asthma education for physicians on patient satisfaction and use of health services. Eur Respir J 2000;16:15–21.
9. Smith S, Mitchell C, Bowler S. Standard versus patient-centred asthma education in the emergency department: a randomised study. Eur Respir J 2008;31:990–997.
10. Sperl-Hillen J, Beaton S, Fernandes O, et al. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Arch Intern Med 2011;171:2001–2010.
11. Fujimori M, Shirai Y, Asai M, et al. Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial. J Clin Oncol 2014;32:2166–2172.
12. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract 2000;49:796–804.
13. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995;152:1423–1433.
14. Van Osch M, Van Dulmen S, Van Vliet L, et al. Specifying the effects of physician’s communication on patients’ outcomes: a randomised controlled trial. Patient Educ Couns 2017;100:1482–1489.
15. Street RL, Cox V, Kallen MA, et al. Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ Couns 2012;89:245–251.
16. Bauer AM, Parker MM, Schillinger D, et al. Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: Diabetes Study of Northern California (DISTANCE). J Gen Intern Med 2014;29:1139–1147.
17. White RO, Eden S, Wallston KA, et al. Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting. Patient Educ Couns 2015;98:144–149.
18. Poland ML, Ager JW, Olson KL, et al. Quality of prenatal care; selected social, behavioral, and biomedical factors; and birth weight. Obstet Gynecol 1990;75:607–612.
19. Simkin P. Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. Part 1. Birth 1991;18:203–210.
20. Cox R, Zhang G, Zotti L, et al. Prenatal care utilization in Mississippi: racial disparities and implications for unfavorable birth outcomes. Matern Child Health J 2011;15:931–942.
21. Melo EC, Oliveira RR, Aidar de Freitas MT. Factors associated with the quality of prenatal care: an approach to premature birth. Rev Esc Enferm USP 2015;49:540–549.
22. Yeoh PL, Hornetz K, Shauki NIA, et al. Evaluating the quality of antenatal care and pregnancy outcomes using content and utilization assessment. Int J Qual Health Care 2018;30:466–471.
23. Reichman NE, Keney GM. Prenatal care, birth outcomes and newborn hospitalization costs: patterns among Hispanics in New Jersey. Family Plann Perspect 1998;30:182–200.
24. Ruiz RL, Shah MK, Lewis MP, et al. Perceived access to health services and provider information and adverse birth outcomes: findings from LAPRAMS, 2007– 2008. South Med J 2014;107:137–143.
25. Tandon SD, Parillo KM, Keefer M. Hispanic women’s perceptions of patient-centeredness during prenatal care: a mixed-method study. Birth 2005; 32:312–317.
26. Wheatley R, Kelley M, Peacock N, et al. Women’s narratives on quality in prenatal care: a multicultural perspective. Qual Health Res 2008;18: 1586–1598.
27. O’Hara MW. Postpartum depression: what we know. J Clin Psychol 2009;65: 1258–1269.
28. O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Ann Rev Clin Psychol 2013;9:379–407.
29. Chanfreau-Coffinier C, et al. Mental health screening results associated with women veterans’ ratings of provider communication, trust, and care quality. Womens Health Issues 2018;28:430–438.
30. Geronimus AT. The weathering hypothesis and the health of AfricanAmerican women and infants: evidence and speculations. Ethn Dis 1992;2: 207–221.
31. Beck CT. Predictors of postpartum depression: an update. Nurs Res 2001;50: 275–285.
32. Institute of Medicine Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press; 2007.
33. Zhang L, Cox R, Graham J, et al. Association of maternal medical conditions and unfavorable birth outcomes: findings from the 1996–2003 Mississippi linked birth and death data. Matern Child Health J 2011;15:910–920.
34. Nanyonjo R, Montgomery S, Modeste N, et al. A secondary analysis of race/ ethnicity and other maternal factors affecting adverse birth outcomes in San Bernardino County. Matern Child Health J 2008;12:435–441.
35. Katon W, Russo J, Gavin A. Predictors of postpartum depression. J Womens Health 2014;23:753–759.
36. Robertson E, Grace S, Wallington T, et al. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004;26:289–295.
37. Schmied V, Johnson MN, Naidoo N, et al. Maternal mental health in Australia and New Zealand: a review of longitudinal studies. Women Birth 2013;26:167–178.
38. Guillory V, Samuels M, Probst J, et al. Prenatal care and infant birth outcomes among Medicaid recipients. J Health Care Poor Underserved 2003;14:272–289.
39. Kaestner R. Health insurance, the quantity and quality of prenatal care, and infant health. Inquiry 1999;36:162–175.
40. Hansell M. Sociodemographic factors and the quality of prenatal care. Am J Public Health 1991;81:1023–1028.
41. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003;41:1284–1292.
42. Centers for Disease Control and Prevention. Births—methods and delivery. https://www.cdc.gov/nchs/fastats/delivery.htm. Accessed December 24, 2020.
43. Centers for Disease Control and Prevention. Preterm birth. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Accessed December 24, 2020.
44. Declercq ER, Sakala C, Corry MP, et al. Listening to Mothers III: Pregnancy and Birth. Report of the Third National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection; 2013.