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Background: Recent expansions in eligibility for coverage of prenatal care services by the Medicaid program reflect national initiatives to improve pregnancy outcomes. This study investigates the potential impact that completeness of reporting of prenatal care and gestational age variables and strategies to impute missing data may have on evaluations of the Medicaid expansion. Methods: This study, examining 15 years of vital record data from a single state and comparing 1 year of data from four mid-Atlantic states, selected single live births to resident mothers for analyses. The "day 15" and the "preceding case" methods were used to impute missing gestational age data. Results: Considerable temporal and geographic variation was detected in completeness of reporting of variables used to construct prenatal care indices. After imputing values for cases with missing data, the proportion of cases for which adequacy of prenatal care utilization could not be determined ranged from 3% to 24% among the states investigated. For those cases where gestational age data could be imputed, the distribution of prenatal care utilization was not markedly disparate from those cases with complete reporting of gestational age. Conclusions: The results indicate that variations in reporting, decisions regarding the treatment of missing data, and the choice of the denominator can alter prenatal care utilization percentages and have implications for evaluations of the impact of the recent Medicaid expansion on prenatal care utilization. [ABSTRACT FROM AUTHOR]

Utilizing the 1980 Induced Abortion File maintained by the National Center for Health Statistics, we compared gestational age from date of last normal menses and the physician-based estimate of gestational age. An average .51 week difference between the two methods was observed. Beyond seven weeks gestation, the date of last normal menses value was underestimated by the physician-based estimate with a markedly greater divergence after 20 weeks. A relatively greater underestimation of the date of last normal menses interval by the physician estimate was apparent for Whites after 13 weeks. The date of last normal menses value for non-state residents was overestimated across the entire range of the date of last normal menses gestational age distribution until 21 weeks. (Am J Public Health 1989; 79:603-606.) [ABSTRACT FROM AUTHOR]

Utilizing 10,587 cases from the 1980 National Center for Health Statistics Fetal Death Statistics File, we examined the comparability of two methods of determining the gestational age of a fetal death, the calculated interval from date of last normal menses (DLNM) and the physician's estimate. The physician estimated gestational age distribution exhibits even number digit preference and a distinct clustering at the 40-week value. The DLNM distribution appears more smoothly distributed but with a more pronounced post-term tail. An exact agreement between the two methods is observed in only 27.9 per cent of the cases. A 1.7 week mean difference between the methods indicates a systematic underestimation by physician reported gestational age when compared to that calculated from the DLNM, potentially biasing gestational age distributions when the physician estimate is substituted for cases with a missing DLNM. Over 8 per cent of cases 20+ weeks by DLNM are estimated as <20 weeks by the physician. This underestimation has important implications for the completeness of reporting of fetal deaths on vital records and the comparability of fetal death rates. Further, it may limit investigations of the completeness of reporting of <500 gram live births. (Am J Public Health 1989; 79:600-602.) INSET: AAP Releases Circumcision Statement. [ABSTRACT FROM AUTHOR]