344: Impact of delayed initiation of prenatal care on neonatal outcomes

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Past studies on prenatal care (PNC) have focused on maternal outcomes associated with inadequate PNC and maternal and social predictors for inadequate or delayed PNC. We aimed to determine the effect of delayed initiation of PNC on rates of NICU admission and NICU length of stay. A retrospective cohort study of non-anomalous, singleton pregnancies comparing neonatal outcomes between women who initiated prenatal care early vs. delayed (>20-week gestational age) at Oregon Health and Science University from 2009-2015, stratified by obesity at the time of delivery (obese = BMI≥30, non-obese = BMI <30). We examined rates of NICU admission and NICU length of stay. To adjust for non-normal distribution and account for outliers, we excluded neonates with a NICU length of stay greater than two standard deviations from the mean. Chi- square was used to compare rates between early and delayed care pregnancies. Multivariate logistic regression analysis was utilized to determine the strength of association between initiation of care and adverse neonatal outcomes when adjusting for maternal age and race, gestational age at delivery, BMI, pre-gestational diabetes, chronic HTN, smoking, insurance status, pre-eclampsia, gestational diabetes, and cesarean section. A p-value of less than 0.05 indicated statistical significance. Of the 7741 pregnancies at OHSU, 7086 were analyzed after exclusions with 3895 (54.97%) in the obese group and 3191 (45.03%) in the non-obese group. Delayed initiation of PNC was associated with a statistically significant increase in rates of NICU admission in both obese (aOR, 1.58; 95% CI 1.26-1.98) and non-obese (aOR, 1.42; 95% CI 1.07-1.89) pregnancies. The overall NICU length of stay was not statistically significant with delayed initiation of PNC in infants of both obese and non-obese pregnancies, although the median number NICU days was higher with delayed PNC in both cohorts. Delayed Initiation of PNC was associated with increased rates of NICU admission in non-obese and obese patients. These findings suggest that earlier initiation of PNC may provide more opportunities to improve maternal health and reduce adverse neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)