Risk, antepartum care, and outcome: impact of a maternity and infant care project.

A Title V Maternity and Infant Care (M&I) Project has been operating from Cleveland Metropolitan General Hospital for more than 13 years. To evaluate the effectiveness of its program of antepartum care, social and medical-obstetric risk factors and perinatal outcome were evaluated for pregnant women delivered during a 2-year period. After the potential biases of patient referral and failure to obtain antepartum care were excluded, patients who received either M&I or non-M&I care were compared. Despite the similar social and antepartum/intrapartum risk of these groups, the M&I patients experienced 60% less perinatal mortality than the non-M&I group (P less than .0001). These results suggest that M&I antepartum care is of considerable value, possibly ameliorating the risks for preterm delivery. M&I patients receive more patient education, nutrition counseling, social service assessment and intervention, special services for adolescents, and delinquent appointment follow-up. Thus, this study further suggests that these components of antepartum care may be important in producing the observed improvement in fetal-infant outcome.