Also, the APNCU
Index only assesses adequacy of prenatal care utilization and does not provide information on the quality of the prenatal care that is delivered (Kotelchuck, 1994).
Furthermore, intensive use of prenatal care increased among both white (R-GINDEX, from 18% to 30%; APNCU, from 3% to 7%) and black women (R-GINDEX, from 20% to 31%; APNCU, from 4% to 7%).
White women had greater gains than black women in intensive use of prenatal care as measured by both the APNCU (68% vs.
First, the summary index for adequacy of prenatal care was developed using Kotelchuck's APNCU
. Second, those intervening variables that might influence adequacy of prenatal care, other than access barriers, were identified.
CDHS defines APNCU as care initiated during the first 4 months of pregnancy, followed by [greater than or equal to]80% of the expected total number of visits recommended by the American College of Obstetricians and Gynecologists (ACOG), adjusted for the length of gestation (3).
In comparison, the rate of APNCU increased 18.2%, from 56.2 per 100 to 66.4 per 100, an annual rate of increase of 2.2 per 100 per year.
During 1989-1994, rates of APNCU increased within all payment source categories.
Editorial Note: The findings in this report indicate that in California during 1989-1994, the rate of first-trimester initiation of prenatal care increased 6.9%; in contrast, the overall rate of APNCU increased 18.2%.
It is true that both the Kessner Index and the APNCU take into account the initiation and intensity of care, as well as gestational age at delivery.
If one's concern, however, is to inquire whether the timing effect of care initiation is linear or nonlinear, I then believe that employing the Kessner Index or the APNCU adds little value to the use of the timing of care.
The Kessner and APNCU
indexes are advantageous for several reasons in addition to allowing for the nonlinear effects of prenatal care on birthweight outcomes.
In 1994, Kotelchuck published the Adequacy of Prenatal Care Utilization (APNCU
) index (1994b), an important methodological advance in the measurement of prenatal care use and effectiveness.