Birth Outcome in Incarcerated, High-Risk Pregnant Women

摘要

Increasingly more women are being jailed in the United States, and more than 80 percent of them are of childbearing age. One report claimed that 6 percent of women are pregnant when entering prison. This study compares pregnancy outcomes in 31 women who were incarcerated during the second trimester and delivered at Boston Medical Center, where care was based on community standard prenatal guidelines formulated by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics (group 1). Basic prenatal care is provided in prison by an obstetrician-gynecologist and either a nurse practitioner or registered nurse. Prisoners are brought to the Boston Medical Center for special evaluation as needed and deliver there. The comparison groups included 47 women enrolled in a methadone maintenance program (group 2) and 71 randomly chosen parturients (group 3). Women in all three groups had an average age of 29 years.None of the imprisoned women delivered before term. Infant birthweights averaged 3165, 2963, and 3264 gm in groups 1, 2, and 3, respectively. The respective frequencies of low-birthweight (LBW) infants were 9.7, 21.3, and 4.2 percent. Although median Apgar scores were the same in all groups, more group 2 infants had scores of 7 or below at 1 and 5 minutes. Older women tended to have lower-birthweight infants. LBW also correlated with the number of prenatal visits, but this trend was only of borderline significance. Multiple regression analysis indicated that jailed women were slightly more likely than control subjects to have a LBW infant, but those on methadone maintenance were twice as likely as incarcerated women to have a LBW infant.These results do not agree with previously reported findings that pregnancy outcomes are poorer among imprisoned women. Nevertheless, alternatives such as drug-free residential facilities deserve consideration. On-site prenatal care is appropriate for high-risk women who previously used drugs. Birth outcomes will improve once drug use ceases and women are provided adequate food and shelter and a less stressful existence.J Reprod Med 2000;45:190–194