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Best prenatal care is offered at HMOs, but participants have more birth complications, study says

Women enrolled in health maintenance organizations get better access to prenatal care than those with private insurance, but they also have more labor and delivery complications, according to a study released Monday.

Researchers who analyzed 8,000 birth records of babies delivered in 1992 and 1993 in Washington state found that women enrolled in HMOs were 40 percent less likely to receive inadequate prenatal care and were 30 percent more likely to give birth to a baby weighing more than 5.5 pounds.But, for reasons not understood, the researchers found that HMO patients with no obstetrical risk factors were 40 percent more likely to have labor and delivery complications.

"It is unclear whether the trends reflect unmeasured differences between the groups or whether there are truly differences in labor and delivery management," the authors said.

One explanation, they suggested, is that HMO hospitals may have more thorough record-keeping, and thus would be more apt to include details on labor and delivery in the records that were analyzed.

The study also found that babies born to women with HMO coverage are about 80 percent more likely to show signs of distress.

The authors said the reasons for the differences are not clear, but they suggested that a study using more detailed medical data could uncover the answer.

"Following women from the first prenatal visit through delivery would be an effective means of further clarifying those potentially important differences," they said.

The study is to be published in the November issue of the Archives of Pediatrics & Adolescent Medicine, a publication of the American Medical Association.

Hospital stays were about two days for both groups, but the HMO mothers and infants were less likely than those covered by private insurance to stay in the hospital for more than four days.