Protocol - Adequacy of Prenatal Care

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Dates of prenatal care visits are abstracted from medical record or birth certificate data.

Specific Instructions:

The abstractor should determine the gestational age at the time of the first visit. Estimated due date, used to determine gestational age, can be calculated with online calculators (example at http://perinatology.com/calculators/Due-Date.htm)

Abstraction of two crucial dates obtained from birth certificate or medical chart data: initial prenatal care visit (initiation), and the total number of prenatal visits from when prenatal care began until date of delivery (received services).

  1. Month of initiation of care:

[ ] 7-9 or no care

[ ] 5-6

[ ] 3-4

[ ] 1-2

  1. % of recommended visits received

[ ] 0-49 - inadequate

[ ] 50-79 - intermediate

[ ] 80-109 - adequate

[ ] 110+ - adequate plus

Protocol Name from Source:

Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU)



Personnel and Training Required


Equipment Needs


Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Medical record abstraction

Life Stage:

Adolescent, Adult, Pregnancy


Pregnant women

Selection Rationale

Prenatal care is important to the health of both mothers and babies. The earlier a mother/baby receives prenatal care the better. Inadequate prenatal care is related to low birth weight and other negative outcomes.

Compared to other utilization of care indexes, the Kotelchuck Index is preferable because it includes a category for women who receive more than the recommended amount of care (adequate plus, or intensive utilization).



Common Data Elements (CDE) Pregnancy Prenatal Care Assessment Text 5633401 CDE Browser
Human Phenotype Ontology Prenatal maternal abonrmality HP:0002686 HPO
Human Phenotype Ontology Abnormality of prenatal development or birth HP:0001197 HPO
Derived Variables


Process and Review

Not applicable.


Kotelchuck, M. (1994). The Adequacy of Prenatal Care Utilization Index: Its US distribution and association with low birthweight. American Journal of Public Health, 84(9), 1486-1489.

Certification for the Spanish translation can be found here.

General References

Alexander, G. R., & Cornely, D. A. (1987). Prenatal care utilization: Its measurement and relationship to pregnancy outcome. American Journal of Preventive Medicine, 3(5), 243-253.

The two indices and others are compared in:

Alexander, G. R., & Kotelchuck, M. (1996). Quantifying the adequacy of prenatal care: A comparison of indices. Public Health Reports, 111(5), 408-418; discussion 419.

Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health, 84(9), 1414-1420.

Protocol ID:


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX240101010000 Month of initiation of care N/A
PX240101020000 Percent of recommended visits received N/A
Measure Name:

Adequacy of Prenatal Care

Release Date:

January 31, 2017


Adequacy of prenatal care assessed by the month of the initial visit in the pregnancy and total number of prenatal visits.


To determine the adequacy of prenatal care with the month at which the initial prenatal care visit occurred in a pregnancy and the total prenatal care visits through delivery with that number being calculated as a percentage of recommended visits.


Pregnancy, prenatal care, doctor visits, Kotelchuck Index, Adequacy of Prenatal Care Utilization, APNCU