Tangible differences between adolescent-oriented and adult-oriented prenatal care.

Comprehensive prenatal care reduces many of the risks associated with adolescent childbearing. To learn why this intervention strategy is successful, we compared the care received by 123 poor, black, younger than 19-year-olds in an adolescent-oriented prenatal program to that received by 72 sociodemographically similar, black, 19-30-year-olds in a university hospital-based prenatal clinic. We found that adolescents entered care later (13.6 +/- 5.6 vs. 11.7 +/- 3.4 weeks; p less than 0.01) and were less likely to obtain an adequate quantity of care then were adults (45.5% vs. 61.1%; p = 0.04). However, teens were enrolled in the Women, Infant, and Children (WIC) food supplement program more rapidly than adults (within 7 +/- 6 vs. 10 +/- 6 weeks of the first prenatal visit; p = 0.002), were referred more often to community service agencies for help with nonobstetric, psychosocial, and financial problems (37.4% vs. 18.3%; p less than 0.0001), and were tested and treated more frequently for sexually transmitted diseases (p less than 0.0001). When the adolescents entered care they were smaller, had lower hematocrits, more social and behavioral problems, poorer diets, and more sexually transmitted diseases than did the adults. Later in gestation, however, hematocrits, diets, weight gain, and birth outcomes were similar in the two groups. The implications of these findings for health care providers and for further research are discussed.