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Medicaid has expanded to cover more pregnant women in order to reduce infant mortality and the proportion of low-birthweight infants. Prenatal care utilization is usually measured by considering the month when prenatal care began, the number of prenatal care visits, gestational age at delivery, and other factors. In many such indices, missing prenatal care data are classified as inadequate prenatal care utilization. The impact of two different methods of dealing with missing data on prenatal care and gestational age on evaluations of Medicaid expansion is examined. Methods of evaluating Medicaid expansion should include reporting completeness, a description of methods for dealing with missing data, and a description of the formula used to calculate prenatal care percentages. Basing the findings on all cases, only 57 percent of women were placed in the adequate category, but when cases with missing data were excluded, 75 percent of the women were assumed to have had adequate care. It is easy to manipulate these and other categories, and such a possibility should not be ignored in the strongly political climate surrounding Medicaid and other programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Using the 1980 Induced Abortion File maintained by the National Center for Health Statistics, the authors compared gestational age (the age of a fetus from the time of fertilization) from date of last normal menstruation and the physician-based estimate of gestational age. An average difference between the two methods of almost exactly half a week was observed. After seven weeks gestation, the date of last normal menstruation 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.

Using cases from the 1980 National Center for Health Statistics Fetal Death Statistics File, the authors compared two methods of determining the gestational age (the age of a fetus from the time of fertilization) of a fetal death, the calculated interval from date of last normal menstruation (DLNM) and the physician's estimate. The physicians' estimates tended towards even numbers and a distinct clustering at the 40-week value. The DLNM distribution graph appears more smoothly distributed but with a more pronounced post-term tail. The two methods match up only a quarter of the time. The study showed that physicians regularly underestimated the gestational age, as compared with the other method. 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 babies born weighing less than 1 pound.

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]