Abstract
BackgroundThe effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries.MethodsWe pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood.ResultsAmong 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations.ConclusionsWhile not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.
Highlights
Prenatal care has long been advocated to improve maternal health and birth outcomes, and together with perinatal and postpartum care, was identified as a key instrument to reach targets such as reduced child mortality as part of Millennium Development Goals 4 and 5 [1], and continues to be a priority in the Sustainable Development Goals (Goal 3) [2]
Each unit increase in the prenatal care utilization index was associated with 0.09 higher height-for-age z-score at 24 months and with 0.26 higher schooling grades attained
While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, higher height-for-age at 24 months and higher attained school grades
Summary
Prenatal care has long been advocated to improve maternal health and birth outcomes, and together with perinatal and postpartum care, was identified as a key instrument to reach targets such as reduced child mortality as part of Millennium Development Goals 4 and 5 [1], and continues to be a priority in the Sustainable Development Goals (Goal 3) [2]. Routine checks including fetal heart auscultation, urinalysis, assessment of maternal weight, blood pressure, and fundal height allow close monitoring of fetal development and reduce birth risk factors. Screening activities such as genetic counseling and testing, ABO and Rh blood typing, and screening for anemia and for neural tube defects and aneuploidy can prevent or mitigate adverse birth outcomes [6]. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries
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