irectly, as it leads to neglect of other risk factors that could be treatable. The other reason that there is a need for focus on this issue is that attitude towards prenatal care is reflective of attitude towards pediatric care. In efforts to explain delayed initiation of prenatal care some logistical risk factors have been designated, the only significant one is transportation, affecting a meek 8% of low-income women in a study carried out in California. 7 The more significant risk factors are more pervasive and require serious health and social reform. In the same study, it was found that of the 28% of women who received untimely care, only 6% of them were unaware of their pregnancies. The women selected for this study were postpartum and had Medicaid or private coverage throughout the duration of their pregnancy. A disturbing 22% of the women blatantly ignored the available care. The significant risk factors identified in this study were unwanted or unplanned pregnancy, no regular provider of care, and no schooling beyond high school, respectively affecting 43%, 66%, 22%, and 76% of women. Unlike transportation, these issues cannot be dealt with easily because they are out of the control o f the care giver during pregnancy, they are events that have already taken place. In another study conducted a major risk factor was residence in a distressed urban neighborhood. 2 Both these studies emphasize the need for outreach and care management for pregnant women, the value of social and health policies, and the importance of encouraging use of prenatal care in Medicaid managed care.Bacterial Vaginosis is another new risk factor, first correlated with spontaneous preterm birth in 1991. 8 There has been much work done on the subject, but with the advent of the Prostaglandin theory, it is beginning to gain force in the field of etiology. Bacterial Vaginosis is an infection in which the normal hydrogen peroxide producing Lactobacil...
