Prenatal factors and birth outcomes in the public health service: a rural/urban comparison.

To determine whether predictors of birth outcomes differ for women in rural versus urban areas, data were obtained from the health records of women who received prenatal care through the Public Health Departments of a rural (N = 364) and urban (N = 415) setting. The rural group was more apt to be single, less educated, African-American, and have a lower income than the urban group. Rural women also had a higher incidence of low birth weight infants, which may be related to poor nutrition and low weight gain during pregnancy. Urban women had more maternal and neonatal complications, which may be related to a higher incidence of drug use and smoking. Membership in a rural or urban population did not predict low birth weight. Race, weeks gestation at first prenatal visit, number of total visits, and adequacy of diet and weight gain were significant predictors of birth weight. Neonatal complications were higher in the urban group and best predicted by poor diet, alcohol intake, and race. Both rural and urban women received inadequate prenatal care, as indicated by late entry into care and total number of visits. Alternative models of care which explore strategies to individualize care, while providing comprehensive care, should be investigated.