Frequency of Prenatal Care Visits and Perinatal Outcome

To the Editor. —Dr McDuffie and colleagues¹ have met all the requirements of good science in their study of the effect of the frequency of prenatal care visits on perinatal outcome among low-risk women. I have several criticisms of this study, however. First, the catalog of maternal outcomes includes some that could not possibly be affected by any kind of prenatal care: multiple gestation, placenta previa, abruptio placentae, postpartum hemorrhage. Why include these?

Second, our goal in obstetrics should be excellence, not mediocrity. A stillbirth rate of 4 per 1000 is not particularly good in an already low-risk group of patients. We should not seek to see how few visits can preserve the average outcome. If efficiency is the issue, the question should be how few visits can preserve the best outcome. Similarly, the preterm and low-birth-weight rates are unimpressive in this low-risk group of insured patients. Although standard