Inequities in Prenatal Care for Socially and Medically Vulnerable Pregnancies in North Carolina

To examine the structural and health-related risk factors associated with prenatal care (PNC) adequacy among women in North Carolina as measured by the Kotelchuck Prenatal Care Index, a retrospective cohort study was designed to utilize data from the 2017 to 2021 Pregnancy Risk Assessment Monitoring System. The analysis used the independent t-test, chi-square tests, and logistic regression modeling to examine study objectives. The study population comprises 286,835 women with documented live births and recorded Kotelchuck PNC Index scores; 77% received adequate PNC. Receiving adequate PNC was more primarily attributed to White women, married, privately insured, and educated women (P < 0.001). Risk factors such as prepregnancy body mass index (BMI), smoking, diabetes, hypertension, previous preterm birth, and infections significantly impacted adequate PNC, often favoring White women. Black and American Indian/Alaska Native (AI/AN) women had a lower likelihood (P < 0.001) of receiving adequate PNC across BMI categories. AI/AN women who smoked during pregnancy had lower odds of adequate PNC (P < 0.001). Black and AI/AN women with previous poor pregnancy outcomes and previous preterm birth had lower odds of adequate PNC (P < 0.05). Sociodemographic factors, health behaviors, and preexisting medical conditions contribute to pervasive inequities among women of color. Targeted interventions and evidence-informed policy reforms are essential to reducing disparities and improving maternal and neonatal health outcomes.