• Elizabeth Wall-Wieler, Kathleen Kenny, Janelle Lee, Kellie Thiessen, Margaret Morris, and Leslie L Roos.
• Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC ewallwie@stanford.edu.
• CMAJ. 2019 Feb 25; 191 (8): E209-E215.

BackgroundPrenatal care is one of the most widely used preventive health services; however, use varies substantially. Our objective was to examine prenatal care among women with a history of having a child placed in out-of-home care, and whether their care differed from care among women who did not.MethodsWe used linkable administrative data to create a population-based cohort of women whose first 2 children were born in Manitoba, Canada, between Apr. 1, 1998, and Mar. 1, 2015. We measured the level of prenatal care using the Revised Graduated Prenatal Care Utilization Index, which categorizes care into 5 groups: intensive, adequate, intermediate, inadequate and no care. We compared level of prenatal care for women whose first child was placed in care with level of prenatal care for women who had no contact with care services, using 2 multinomial logistic regression models to calculate odds ratios (ORs).ResultsIn a cohort of 52 438 mothers, 1284 (2.4%) had their first child placed in out-of-home care before conception of their second child. Mothers whose first child was placed in care had much higher rates of inadequate prenatal care during the pregnancy with their second child than mothers whose first child was not placed in care (33.0% v. 13.4%). The odds of having inadequate rather than adequate prenatal care were more than 4 times higher (OR 4.29, 95% CI 3.68 to 5.01) for women who had their first child placed in care than for women who did not have their first child placed in care.InterpretationMothers with a history of having a child taken into care by the child protection services system are at higher risk of having inadequate or no prenatal care in a subsequent pregnancy compared with mothers with no history of involvement with child protection services.© 2019 Joule Inc. or its licensors.

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