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Frequency of Prenatal Care Visits and Perinatal Outcome FREE

Richard W. Zalar, Jr, MD
JAMA. 1996;276(2):101-101. doi:10.1001/jama.1996.03540020023015
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To the Editor.  —Dr McDuffie and colleagues1 have met all the requirements of good science in their study of the effect of the frequency of prenatal care visits on perinatal outcome among low-risk women. I have several criticisms of this study, however. First, the catalog of maternal outcomes includes some that could not possibly be affected by any kind of prenatal care: multiple gestation, placenta previa, abruptio placentae, postpartum hemorrhage. Why include these?Second, our goal in obstetrics should be excellence, not mediocrity. A stillbirth rate of 4 per 1000 is not particularly good in an already low-risk group of patients. We should not seek to see how few visits can preserve the average outcome. If efficiency is the issue, the question should be how few visits can preserve the best outcome. Similarly, the preterm and low-birth-weight rates are unimpressive in this low-risk group of insured patients. Although standard

REFERENCES

McDuffie RS, Beck A, Bischoff K, Cross J, Orleans M.  Effect of frequency of prenatal care visits on perinatal outcome among low-risk women: a randomized controlled trial . JAMA . 1996;;275:847-851.
Hillier SL, Nugent RF, Eschenbach DA, et al.  Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant . N Engl J Med . 1995;;333:1737-1742.
Iams JD, Casal D, McGregor JA, et al.  Fetal fibronectin improves the accuracy of diagnosis of preterm labor . Am J Obstet Gynecol . 1995;;173:141-145.
Iams JD, Goldenberg KL, Meis PJ, Mercer BM, Moawad A, Das A.  The length of the cervix and the risk of spontaneous premature delivery . N Engl J Med . 1996;;334:567-572.

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McDuffie RS, Beck A, Bischoff K, Cross J, Orleans M.  Effect of frequency of prenatal care visits on perinatal outcome among low-risk women: a randomized controlled trial . JAMA . 1996;;275:847-851.
Hillier SL, Nugent RF, Eschenbach DA, et al.  Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant . N Engl J Med . 1995;;333:1737-1742.
Iams JD, Casal D, McGregor JA, et al.  Fetal fibronectin improves the accuracy of diagnosis of preterm labor . Am J Obstet Gynecol . 1995;;173:141-145.
Iams JD, Goldenberg KL, Meis PJ, Mercer BM, Moawad A, Das A.  The length of the cervix and the risk of spontaneous premature delivery . N Engl J Med . 1996;;334:567-572.
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