Protocol - Adequacy of Prenatal Care

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Protocol Name from Source:

Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU)


Publicly available


Dates of prenatal care visits are abstracted from medical record or birth certificate data.


  1. Month of initiation of care:

[ ] 7-9 or no care

[ ] 5-6

[ ] 3-4

[ ] 1-2

  1. % of recommended visits received

[ ] 0-49 - inadequate

[ ] 50-79 - intermediate

[ ] 80-109 - adequate

[ ] 110+ - adequate plus

Personnel and Training Required


Equipment Needs



Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration


Life Stage:

Adolescent, Adult, Pregnancy

Specific Instructions:

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).

Research Domain Information

Release Date:

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.

Selection Rationale

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 Text5633401CDE 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.

General References

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.

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