Protocol - Adequacy of Prenatal Care
Protocol Name from Source:
Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU)
Dates of prenatal care visits are abstracted from medical record or birth certificate data.
- Month of initiation of care:
[ ] 7-9 or no care
[ ] 5-6
[ ] 3-4
[ ] 1-2
- % of recommended visits received
[ ] 0-49 - inadequate
[ ] 50-79 - intermediate
[ ] 80-109 - adequate
[ ] 110+ - adequate plus
Personnel and Training Required
|Average time of greater than 15 minutes in an unaffected individual||No|
|Specialized requirements for biospecimen collection||No|
Mode of Administration
Adolescent, Adult, Pregnancy
The abstractor should determine the gestational age at the time of the first visit. Estimated due date, used to determine gestational age, can be calculated with online calculators (example at [link[perinatology.com/calculators/Due-Date.htm|http://perinatology.com/calculators/Due-Date.htm]])
Abstraction of two crucial dates obtained from birth certificate or medical chart data: initial prenatal care visit (initiation), and the total number of prenatal visits from when prenatal care began until date of delivery (received services).
January 31, 2017
Adequacy of prenatal care assessed by the month of the initial visit in the pregnancy and total number of prenatal visits.
To determine the adequacy of prenatal care with the month at which the initial prenatal care visit occurred in a pregnancy and the total prenatal care visits through delivery with that number being calculated as a percentage of recommended visits.
Prenatal care is important to the health of both mothers and babies. The earlier a mother/baby receives prenatal care the better. Inadequate prenatal care is related to low birth weight and other negative outcomes.
Compared to other utilization of care indexes, the Kotelchuck Index is preferable because it includes a category for women who receive more than the recommended amount of care (adequate plus, or intensive utilization).
|Common Data Elements (CDE)||Pregnancy Prenatal Care Assessment Text||5633401||CDE Browser|
Process and Review
The Expert Review Panel has not reviewed this measure yet.
Kotelchuck, M. (1994). The Adequacy of Prenatal Care Utilization Index: Its US distribution and association with low birthweight. American Journal of Public Health, 84(9), 1486-1489.
Certification for the Spanish translation can be found here.
Alexander, G. R., & Cornely, D. A. (1987). Prenatal care utilization: Its measurement and relationship to pregnancy outcome. American Journal of Preventive Medicine, 3(5), 243-253.
The two indices and others are compared in:
Alexander, G. R., & Kotelchuck, M. (1996). Quantifying the adequacy of prenatal care: A comparison of indices. Public Health Reports, 111(5), 408-418; discussion 419.
Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health, 84(9), 1414-1420.
|Variable Name||Variable ID||Variable Description||Version||dbGaP Mapping|