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Joyce M. Piper, DrPH; Wayne A. Ray, PhD; Marie R. Griffin, MD, MPH
Vanderbilt University School of Medicine Nashville, Tenn

JAMA. 1991;265(8):975.

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In Reply.—

We appreciate the comments of Drs Jameson, Moore, and Page, which reiterate several important aspects of our study. Since the behaviors described by Dr Jameson are recognized as risk factors for poor pregnancy outcomes, efforts to modify them through education and supportive services should be part of comprehensive prenatal care. Although Dr Moore's finding (that only 5% of pregnant teenagers in Pueblo fail to obtain prenatal care because of financial reasons) under-estimates this problem nationally,^1-3 his experience illustrates the need for out-reach in the provision of prenatal services. The overall decrease in neonatal mortality cited by Dr Page occurred primarily among unmarried women whose eligibility for Medicaid was not affected by the regulatory change we studied. Thus, this decrease probably reflects the temporal trend in neonatal mortality. Although there is a similar problem with his alternative analysis, it under-scores the point that those mothers at highest risk . . . [Full Text PDF of this Article]

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