Table 2:

Definitions of outcomes used to compare prenatal health care utilization among women whose child(ren) had a diagnosis of FASD and women whose child(ren) did not have a diagnosis of FASD

OutcomeDefinition or method of calculation
Late initiation of prenatal careThe woman’s prenatal care began after the first trimester (date of conception to 91 d)
No careThe woman received no prenatal care in the first, second or third trimester
Care initiated in first trimesterThe woman’s first prenatal visit was in the first trimester (date of conception to 91 d)
Care initiated in second trimesterThe woman’s first prenatal visit was in the second trimester (92–189 d)
Care initiated in third trimesterThe woman’s first prenatal visit was in the third trimester (190 d to date of birth)
Low number of prenatal visitsThe woman had fewer than 5 prenatal visits before delivery
Inadequate or no prenatal careThe proportion of women with no or inadequate prenatal care was determined using the R-GINDEX.
Quality of prenatal care by the R-GINDEXThe R-GINDEX is a measure of the adequacy of prenatal care by a health care provider that identifies 6 major categories of prenatal care: inadequate prenatal care, intermediate prenatal care, adequate prenatal care, intensive care, no care and missing information. (10) Knowledge of 3 birth-related outcomes is required to calculate the R-GINDEX:

  • the gestational age of the infant (date of pregnancy and birth) as calculated from the hospital abstract (10);

  • the trimester during which prenatal care began, using hospital abstracts and physician claims data (the ICD-9-CM tariffs that were included are 8400, 8401, 8501, 8507, 8509, 8529, 8540, 8550 (10)); and

  • the total number of prenatal visits during pregnancy as calculated from hospital abstracts and physician claims. (10)

Inadequate PNCThe proportion of women with inadequate prenatal care was determined using the R-GINDEX.
Intermediate PNCThe proportion of women with intermediate prenatal care was determined using the R-GINDEX.
Adequate PNCThe proportion of women with adequate prenatal care was determined using the R-GINDEX.
Intensive PNCThe proportion of women with intensive prenatal care was determined using the R-GINDEX. Women whose number of visits was approximately 1 standard deviation above the mean number of visits for other women whose prenatal care was initiated in the same trimester and whose baby was the same gestational age at delivery were labelled as intensive care users. (10) “These women had an unexpectedly large number of PNC visits, which may indicate potential morbidity or complications.” (10)
No careThe proportion of women with no prenatal care in any trimester was determined using the R-GINDEX.

  • Note: FASD = fetal alcohol spectrum disorder, R-GINDEX = Revised Graduated Prenatal Care Utilization Index.