Are neonatal morbidities associated with no prenatal care different from those associated with inadequate prenatal care?

Abstract

Objective: Compare neonatal morbidities in women with no prenatal care, and women with inadequate prenatal care, to those with adequate prenatal care. Methods: Retrospective cohort study of neonatal mor- bidities of 3 exposure groups. Group 1: No prenatal care; Group 2: Inadequate prenatal care; Group 3: Intermediate/adequate prenatal care. Results: 2.5%, 23.3% and 74.1% of subjects (N = 264,138) were in Groups 1, 2 and 3 respectively. Severe neonatal mor- bidity was more common in Group 1, followed by Group 2, and least common in Group 3. After con- trolling for gestational age and birth weight, most of these differences were attenuated and not significant except for the following Group 1 vs Group 3 com- parisons: meconium aspiration, odds ratio (OR) 2.15 and 95% confidence interval (CI) 1.39 - 3.33; sus- pected sepsis, OR 1.30 and CI 1.13 - 1.49; proven vi- ral sepsis, OR 2.23 and CI 1.24 - 4.00. Conclusions: Severe neonatal morbidity was most common in those with no prenatal care followed by those with inade- quate prenatal care. For most neonatal morbidities, this could largely be explained by gestational age and birth weight differences, but for some neonatal mor- bidities (meconium aspirations, viral sepsis and dys- morphic features) the impact of no prenatal care per- sisted after adjustment for these factors. Keywords: Prenatal Care; Neonatal Outcomes; Retrospective Cohort Study 1. INTRODUCTION According to the most recent estimates, 343,000 mothers died in 2008 from complications related to pregnancy and