Despite the received wisdom that early and comprehensive prenatal care improves birth outcomes, many studies have found small or no effects. This does not mean that prenatal care confers minimal health benefits to children, however. Most research on the effectiveness of prenatal care has focused on birth outcomes-usually birth weight or infant mortality. It is possible that prenatal care during the confines of a pregnancy is often """"""""too little too late"""""""" to improve the outcome of that pregnancy, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. According to the Public Health Service's Expert Panel on the Content of Prenatal Care, a broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. However, few studies have examined the effects of prenatal care on pediatric health care utilization or parenting practices. As far as I know, no studies have examined the effect of prenatal care on longer-term child health outcomes. To address these research gaps, I will use data from the Fragile Families and Child Wellbeing birth cohort study to estimate the effects of prenatal care (timing and adequacy) on pediatric health care utilization, health-related parenting behaviors, and child health outcomes in the pre-school years. I will address the potential endogeneity of prenatal care by using rich data and by estimating instrumental variables models.
The specific aims are to: (1) Estimate the effects of prenatal care use on the utilization of pediatric health care (e.g., well-child care, regular source of care, dental visits) and maternal health-related parenting behaviors (e.g., breastfeeding, smoking in the home, feeding practices, regular bed time, dental care, cleanliness of the home) during the child's first five years. (2) Estimate the effects of prenatal care use on child health outcomes (e.g., asthma, overweight, lead poisoning, accidents/injuries). The results will fill an important gap in the literature and lead to a more complete understanding of the benefits of prenatal care. Relevance: Most research on the effectiveness of prenatal care has focused on birth outcomes- usually birth weight or infant mortality-and has found small or no effects. However, the focus on birth outcomes represents a relatively narrow view of the potential of prenatal care. To more fully assess the benefits of prenatal care, it is necessary to consider longer-term impacts. Very little is known about the effects of prenatal care on pediatric health care utilization, health-related parenting behaviors, or child health outcomes. The few existing studies do not address the potential endogeneity of prenatal care use. These knowledge gaps will be addressed as part of the proposed research project.
| Noonan, Kelly; Corman, Hope; Schwartz-Soicher, Ofira et al. (2013) Effects of prenatal care on child health at age 5. Matern Child Health J 17:189-99 |
| Reichman, Nancy E; Corman, Hope; Noonan, Kelly et al. (2010) Effects of prenatal care on maternal postpartum behaviors. Rev Econ Househ 8:171-197 |
