Impact Of Antenatal Care Research Articles

The Impact of Antenatal Care and Pre-Referral Emergency Management on Eclampsia-Related Maternal Mortality in a Low-Resource Setting

Backgrounds: Maternal mortality due to eclampsia had a high case fatality rate. This is frequently due to a failure in detection and monitoring during the ANC, as well as inadequate emergency management of eclampsia. Objective: To determine the impact of ANC and pre-referral emergency management of eclampsia-related maternal death at Dr. Soetomo and Airlangga University Hospital, Surabaya, Indonesia Methods: Analytical study with a retrospective cohort design from 2022-2023, using medical records of eclampsia patients referred to Dr. Soetomo Hospital and Airlangga University Hospital to investigate the relationship between ANC, pre-referral emergency management of eclampsia-related maternal death. Bivariate analysis used the Chi-square test, while multivariate analysis used logistic regression. Results: A total of 59 out of 65 patients met the inclusion criteria. Statistical analysis showed that study subjects aged ≥ 35 years had an association with maternal mortality in eclampsia cases (p = 0.007). A significant relationship also occurred in subjects who were not screened for preeclampsia (p = 0.013) and subjects who did not receive inadequate management of eclampsia (p = 0.000). Conclusion: Pre-referral emergency management of eclampsia is associated with eclampsia-related maternal death, hence health facilities must increase their ability to address eclampsia emergencies before referral.

Impact of antenatal care on severe maternal and neonatal outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana.

To explore how specific measures of antenatal care utilization are associated with outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. Participants were adult pregnant women with preeclampsia or eclampsia at a tertiary hospital in Ghana. Antenatal care utilization measures included timing of first visit, total visits, facility and provider type, and referral status. Antenatal visits were characterized by former and current World Health Organization recommendations, and by gestational age-based adequacy. Composites of maternal complications and poor neonatal outcomes. Multivariate logistic regressions identified associations with antenatal care factors. Among 1176 participants, median number of antenatal visits was 5.0 (IQR 3.0-7.0), with 72.9% attending ≥4 visits, 19.4% attending ≥8 visits, and 54.9% attending adequate visits adjusted for gestational age. Care was most frequently provided in a government polyclinic (n=522, 47.2%) and by a midwife (n=704, 65.1%). Odds of the composite maternal complications were lower in women receiving antenatal care at a tertiary hospital (aOR 0.47, p=0.01). Odds of poor neonatal outcomes were lower in women receiving antenatal care at a tertiary hospital (aOR 0.56, p<0.001), by a specialist Obstetrician/Gynecologist (aOR 0.58, p<0.001), and who attended ≥8 visits (aOR 0.67, p=0.04). Referred women had twice the odds of a maternal complication (aOR 2.12, p=0.007) and poor neonatal outcome (aOR 1.68, p=0.002). Fewer complications are seen after receiving antenatal care at tertiary facilities. Attending ≥8 visits reduced poor neonatal outcomes, but didn't impact maternal complications. Quality, not just quantity, of antenatal care is essential.

The Impact of Antenatal Care and Nutrition Counseling on the Success of Exclusive Breastfeeding and Appropriate First Complementary Foods

Background: Proper breastfeeding and complementary feeding at the beginning of birth until the age of 24 months has an important role in optimizing nutrition for the first 1000 days of life to obtain optimal individual health status until adulthood. Objectives: This study aims to analyze the impact of antenatal care (ANC) and postnatal care (PNC), especially nutritional counseling on the success of exclusive breastfeeding and appropriate complementary foods. Methods: This study used a cross-sectional design from secondary data from basic health research (RISKESDAS) in DKI Jakarta Province with a total sample of 230 mothers aged 15-49 years who had children aged 6-24 months. Data were analyzed univariate, bivariate using the Chi-Square test and multivariate using multiple logistic regression tests. Results: The results showed that the coverage of exclusive breastfeeding was 56.5% and proper complementary food was 39.6%. The results of the Chi Square test showed that there was a relationship between exclusive breastfeeding and maternal age (p = 0.025) (OR: 2.21 95% CI: 1.09 – 4.48), maternal education (p = 0.008) (OR: 4.80 95% CI: 1.79 – 12.8) , maternal parity (p = 0.009) (OR: 2.58 95% CI: 1.25 – 5.30), antenatal care (p = 0.000) (OR: 4.82 95% CI: 2.13 – 10.9), and postnatal counseling (p = 0.006) (OR: 2.72 95% CI: 1.31 – 5.65). Meanwhile, on the accuracy of complementary feeding, there was a relationship between maternal age (p = 0.027) (OR 2.32 95% CI 1.07-5.02), maternal education (p = 0.000) (OR 3.16 95% CI 1.67-5.98), maternal parity (p = 0.027) (OR 2.36 95% CI 1.08- 5.17), received ANC (p = 0.000) (OR 4.61 95% CI 1.84-11.6), and nutrition counseling (p = 0.004) (OR 2.98 95% CI 1.38-6.43). The most dominant variable with the success of exclusive breastfeeding and complementary feeding for the first time is ANC with odds ratios of 4.82 and 4.08, respectively, after being controlled by postnatal counseling. Conclusion: This study shows that the impact of ANC and PNC, especially nutritional counseling, has a role in the success of exclusive breastfeeding and the appropriateness of giving complementary foods for the first time. ANC and PNC, especially nutrition counseling, are very important for every pregnant woman and need to be socialized to relevant policy makers and pregnant women's families.

Impact of Antenatal Care on Perinatal Outcomes in New South Wales, Australia: A Decade-Long Regional Perspective.

Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child's healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant.

Impact of antenatal care on pregnancy outcomes: A cross-sectional study in a rural community in Malaysia

Background: Malaysia has a high standard of health-care system, including antenatal care (ANC) services. Objective: This cross-sectional study was carried out to assess the impact of regular ANC visits on outcome in a rural community in Malaysia from September to November, 2019, in village Kampung Merbok in Kedah, Malaysia. Method and Materials: A pretested semi-structured questionnaire was used as a tool for data collection among the women who gave birth in public or private health-care centers. Association between the various components of ANC and pregnancy outcome was examined using multivariate logistic regression analysis, and Chi-square test/Fisher's exact test was used to interpret the association between the ANC visits and the outcome variables. Result: Among the respondents, 39 (78%) had more than four ANC visits. Fourteen (28%) respondents had adverse pregnancy outcome. All nonattendees had adverse outcome. Only 6 (12%) women (95% confidence interval: 3.22, 20.78) had a history of cesarean section. This study found statistically significant association between maternal ANC visits and maternal and neonatal outcome variables (P < 0.05). Pearson's correlation test also revealed the strong relationship between ANC and the outcome variables (P < 0.0001). Conclusion: In this study, mothers having regular ANC visits experienced better pregnancy outcome compared to those nonattendees. Nevertheless, it is necessary to adhere to a minimum level of four ANC visits for all pregnant women. More health promotion programs are required focusing on improving women's awareness of the necessity of ANC throughout their pregnancy.

The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis.

BackgroundNewborns are at greatest risk of dying at and shortly after the time of birth. Newborn mortality remains an urgent concern and is an important indicator of child health, development and well-being. Studies examining the effectiveness of antenatal care on maternal and newborn health outcomes have provided conflicting results. The aim of this review and meta-analysis was to determine the pooled effect of antenatal care on neonatal mortality in sub-Saharan Africa.MethodsWe searched PubMed, Medline, EMBASE, CINAHL and Google Scholar from September to November 2016 and then updated our search on April 13, 2019. Two independent reviewers extracted data from eligible studies. The quality of each included study was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies (RoBANS). The results were reported based on risk ratio (RR) with 95% confidence intervals (CI) using a random-effects model.ResultsEight hundred and ninety eight studies were initially identified. During screening, 23 studies were found to be relevant for data extraction. Of these, only twelve studies fulfilled the inclusion criteria and were included in the analysis. In five of the twelve studies included in the analysis, antenatal care service utilization had a significant association with neonatal mortality. The pooled risk ratio by the random-effects model was 0.61 (95% CI: 0.43, 0.86) for neonates born to women who received at least one antenatal care visit by a skilled provider as compared to neonates born to women who did not receive antenatal care.ConclusionThis review indicates that utilization of at least one antenatal care visit by a skilled provider during pregnancy reduces the risk of neonatal mortality by 39% in sub-Saharan African countries. Thus, in order to accelerate progress towards the reduction of newborn deaths, all pregnant women should receive antenatal care during pregnancy.

Maternity waiting homes as part of a comprehensive approach to maternal and newborn care: a cross-sectional survey

BackgroundIncreased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns.MethodsA cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data.ResultsThe use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH.ConclusionsThis is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes.Trial registrationNational Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.

Impact of Antenatal Care on Birth Preparedness and Knowledge of Obstetrics Danger Signs in Married Indian Women Attending a Tertiary Care Hospital

Impact of Antenatal Care on Birth Preparedness and Knowledge of Obstetrics Danger Signs in Married Indian Women Attending a Tertiary Care Hospital

The impact of antenatal care, iron-folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh.

BackgroundAppropriate antenatal care (ANC) is an important preventive public health intervention to ensure women’s and newborn health outcomes. The study aimed to investigate the impact of ANC, iron–folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh.MethodA cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0–28 days (neonatal), 1–11 months (post-neonatal) and 12–59 months (child).ResultsMultivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43–0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45–0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49–0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51–0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48–0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36–0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups.ConclusionThe study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.

Obstetric admissions to the intensive care unit of a tertiary hospital in northern India

Objective : To determine the causes of the obstetric admissions to the intensive care unit (ICU) and the impact of antenatal care on ICU admission. Methods : Obstetric ICU admissions over the two years from May 2009 to May 2011 at Maulana Azad Medical College and associated Lok Nayak Hospitals, New Delhi, were analyzed retrospectively. Results : The 136 obstetric admissions to the ICU represented 0.8% of all the deliveries in the hospital during that period. The majority (76%) of women were transferred to the ICU postpartum. Obstetric haemorrhage(56.1%), hypertension(19.8%), and endotoxic shock(12.5%) were the major obstetric cause of the ICU admission. Together with the cardiac disease, DIC, infections, they formed 91.4% of all the admissions. Anaesthetic complications were responsible for 2.9% of them. Of all the admissions, 12% were completely unbooked and uninvestigated during the whole antenatal period, 85% were registered/ booked at other hospitals and 3% were booked in our hospital. The maternal mortality was 19.1% of all the ICU admissions in this study, and the mortality rate in unbooked patients was 58%. Conclusion : The most common precipitants of ICU admission were obstetric haemorrhage and uncontrolled hypertension, both of which can be managed well if the patient has complete antenatal visits and investigations. This reflects the importance of ante-natal care, so that the high risk pregnant female can be identified in advance, referred at appropriate time to the higher centre and managed meticulously.

Impact of Antenatal Care on Maternal and Perinatal utcome: A Study at Nepal Medical College Teaching Hospital

Aims: To identify the determinants of antenatal care (ANC) attendance and its impact on maternal / perinatal outcome. Methods: Prospective descriptive study of women delivered at Nepal Medical College Teaching Hospital (NMCTH), a 700 bedded tertiary care hospital situated at periphery of Kathmandu. Results: Among 322 women delivered during period of four months, majority (87%) reported of attending more than 4 antenatal visits, only 21 (6.5%) women had not attended ANC. The most preferred place of ANC was hospital (71.6%). Women with secondary education and above, business/service holders, 20-29 years age group, primigravida and Brahmin / Chhetri caste were more likely to attend ? 4 visits, while those living further than 6 km. from a health facility were less likely to attend. Financial problem (52.4%) followed by ignorance (28.6%) were the most commonly stated reasons for not attending ANC. Women attending more than 4 antenatal visits have more chance of full immunization with tetanus toxoid and iron supplementation. Most of the women started attending ANC from their second trimester (75.8%), only 21.9% had first ANC visit during first trimester. Overall Cesarean section rate was 17.4% and with increased rates in women who had attended ANC, because of the fact that all elective cesarean section were planned in these women only. Also, all inductions of labor (9.3%) were performed among them. Maternal complications like anemia and pregnancy induced hypertension occurred more commonly in women without ANC. The proportion of low birth weight and preterm babies was higher in women with inadequate or no ANC. Special care baby unit (SCBU) admission was also higher among them due to various reasons like neonatal sepsis, birth asphyxia, jaundice etc. While there were no neonatal deaths during the study period, 3 still births have occurred. Perinatal mortality rate was similar in no ANC and inadequate ANC groups; it was 16 times higher than that in the group with more than 4 visits. Maternal and perinatal outcomes were found to be better in women who attended regular ANC. Conclusions: Although attendance of ANC is quite encouraging, the proportion of women attending ANC from first trimester is low. The quality of antenatal care needs to be strengthened. The health system needs to ensure the availability of ANC in primary care level and to establish mobile clinics for those living far from the health facilities.NJOG 2011 Nov-Dec; 6 (2): 37-43 DOI: http://dx.doi.org/10.3126/njog.v6i2.6755

Is antenatal care effective in reducing maternal morbidity and mortality?

Women in developing countries are dying from simple preventable conditions but what impact can the procedures collectively called antenatal care having in reducing maternal mortality and morbidity? More importantly what is antenatal care? This review found that questions have been raised about the impact of antenatal care (specifically on maternal mortality) since its inception in developed countries, and that although the questions continue to be asked there is very little research trying to find answers. Many antenatal procedures are essentially screening tests yet it was found that there were very few results showing sensitivity and specificity, and that they rarely complied with the established criteria for the effectiveness of a screening test. The acknowledged gold standard measurement of effectiveness is the randomized controlled trial, yet the only results available referred to nutritional supplementation. This service of flawed methodology has been exported to developing countries and is being promoted by WHO and other agencies. This paper argues that there is insufficient evidence to reach a firm decision about the effectiveness of antenatal care, yet there is sufficient evidence to cast doubt on the possible effect of antenatal care. Research is urgently required in order to identify those procedures which ought to be included in the antenatal process. In the final analysis the greatest impact will be achieved by developing a domiciliary midwifery service supported by appropriate local efficient obstetric services. That this domiciliary service should provide care for women in pregnancy is not disputed but the specific nature of this care needs considerable clarification.

A study of antenatal care at village level in rural Tanzania

Antenatal care is an acknowledged measure for the reduction of maternal and perinatal mortality. In the rural village of Ilula, Tanzania, the possible impact of antenatal care on mortality was studied longitudinally on the basis of the 707 women delivered in the study period. Ninety-five percent of the antenatal records were available. Anemia, malaria and anticipated obstetric problems were the utmost frequent reasons for interventions. Among the women from the area who were delivered in hospital, 90% had been referred there. No relationship was found between the number of antenatal visits and the pregnancy outcome, but perinatal mortality was correlated to a low birth weight. Even with a mean attendance rate of six visits and full coverage by antenatal care maternal and perinatal mortality remains high.