Number Of Prenatal Care Visits Research Articles

Inequalities in access to prenatal care during the COVID‐19 pandemic: Analysis of a population‐based cohort

AbstractBackgroundBefore the COVID‐19 pandemic, access to prenatal care was lower among some socio‐demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities.ObjectivesTo investigate if the COVID‐19 pandemic increased inequalities in access to prenatal care among those who are younger, live in rural areas, have a lower socio‐economic situation (SES) and are recent immigrants.MethodsWe used linked administrative datasets from ICES to identify a population‐based cohort of 455,245 deliveries in Ontario from January 2018 to December 2021. Our outcomes were first‐trimester prenatal visits, first‐trimester ultrasound and adequacy of prenatal care. We used joinpoint analysis to examine outcome time trends and identify trend change points. We stratified analyses by age, rural residence, SES and recent immigration, and examined risk differences (RD) with 95% confidence intervals (CI) between groups at the beginning and end of the study period.ResultsFor all outcomes, we noted disruptions to care beginning in March or April 2020 and returning to previous trends by November 2020. Inequalities were stable across groups, except recent immigrants. In July 2017, 65.0% and 69.8% of recent immigrants and non‐immigrants, respectively, received ultrasounds in the first trimester (RD −4.8%, 95% CI −8.0, −1.5). By October 2020, this had increased to 75.4%, with no difference with non‐immigrants (RD 0.4%, 95% CI −2.4, 3.2). Adequacy of prenatal care showed more intensive care as of November 2020, reflecting a higher number of visits.ConclusionsWe found no evidence that inequalities between socio‐economic groups that existed prior to the pandemic worsened after March 2020. The pandemic may be associated with increased access to care for recent immigrants. The introduction of virtual visits may have resulted in a higher number of prenatal care visits.

Influenza vaccine during pregnancy, recommendations from healthcare providers, and race/ethnicity in the United States.

We examined racial/ethnic differences in the association between influenza vaccine recommendations from healthcare providers and maternal vaccination uptake. This cross-sectional study examined data from the Pregnancy Risk Assessment Monitoring System. We categorized respondents as non-Hispanic (NH) Whites, NH-Blacks, NH-Asians, American Indians/Alaska Natives, NH Other non-Whites, and Hispanics. We conducted multivariable logistical regression models to evaluate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Covariates included maternal age, marital status, education, insurance status before pregnancy, the number of previous live births, the number of prenatal care visits, and smoking status during pregnancy. The prevalences of receiving influenza vaccine recommendations from healthcare providers and maternal vaccine were 80.01% and 50.42%, respectively. NH-Blacks are less likely to receive provider recommendations (AOR = 0.82; 95%CI 0.77-0.87) and be vaccinated (AOR = 0.76; 95%CI 0.72-0.80) than NH-Whites. Receiving provider recommendations was significantly associated with increased maternal influenza vaccine uptake (AOR = 15.50; 95% CI 14.51-16.55). The associations were significant for all racial/ethnic groups, with the highest among NH-Asians (AOR = 22.04; 95% CI 17.88-27.16) and the lowest among NH Other non-Whites (AOR = 11.07; 95% CI 8.25-14.86). Within NH-Asians, effectiveness among Chinese was highest (AOR = 29.39; 95% CI 18.10-47.71). Racial/ethnic disparities in maternal influenza vaccine uptake and receiving vaccine recommendations from healthcare providers persisted. Further studies on the racial/ethnic disparities in maternal vaccination were warranted and tailored strategies are required to reduce this health disparity.

Evaluating the Association between Prenatal Care Visits and Adverse Perinatal Outcome in Pregnancies Complicated by Opioid Use Disorder.

This study aimed to evaluate the association between number of prenatal care visits and adverse perinatal outcome among pregnant individuals with opioid use disorder (OUD). This is a retrospective cohort of singleton, nonanomalous pregnancies complicated by OUD that delivered from January 2015 to July 2020 at our academic medical center. Primary outcome was the presence of composite adverse perinatal outcome, defined as one or more of the following: stillbirth, placental abruption, perinatal death, neonatal respiratory distress syndrome, need for morphine treatment, and hyperbilirubinemia. Logistic and linear regression estimated the association between the number of prenatal care visits and the presence of adverse perinatal outcome. A Mann-Whitney U test evaluated the association between number of prenatal care visits and length of hospital stay for the neonate. A total of 185 patients were identified, of which 35 neonates required morphine treatment for neonatal opioid withdrawal syndrome. During pregnancy, most individuals were treated with buprenorphine 107 (57.8%), whereas 64 (34.6%) received methadone, 13 (7.0%) received no treatment, and 1 (0.5%) received naltrexone. The median number of prenatal care visits was 8 (interquartile range: 4-10). With each additional visit per 10 weeks of gestational age, the risk of adverse perinatal outcome decreased by 38% (95% confidence interval [CI]: 0.451-0.854). The need for neonatal intensive care and hyperbilirubinemia also significantly decreased with additional prenatal visits. Neonatal hospital stay decreased by a median of 2 days (95% CI: 1-4) for individuals who received more than the median of eight prenatal care visits. Pregnant individuals with OUD who attend fewer prenatal care visits experience more adverse perinatal outcome. Future research should focus on barriers to prenatal care and interventions to improve access in this high-risk population. · Use of prenatal care affects newborn outcomes.. · More prenatal care shortens neonatal hospital stay.. · Prenatal care reduces certain adverse outcomes..

Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020.

From 2000 to 2020, maternal mortality among adolescents and young adults showed a decreasing trend in the state of Bahia. It could be seen an inverse and significant correlation between the highest number of prenatal care visits and maternal mortality in the studied groups. The study suggests the importance of quality obstetric care during prenatal, childbirth, and postpartum period for reducing maternal mortality among adolescents and young adults, especially from preventable causes. Improving the records of causes of death on information systems, enhancing obstetric care, and investing in sexual and reproductive health policies aimed at adolescents may contribute to the reduction of maternal deaths. to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020. this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation. in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups. maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.

Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool.

Patients receiving care at Federally Qualified Health Centers (FQHCs) have low postpartum care attendance. Perinatal morbidity and mortality disproportionately affect patients with low-income and are potentially preventable. The purpose of this study was to develop a clinical decision support tool to identify FQHC patients less likely to return for postpartum care. To accomplish this purpose, we evaluated established predictors and novel risk factors in our patient population. This is a retrospective, secondary data analysis of 50,022 patients who received prenatal care past 24 weeks' gestation in FQHCs between 2012 and 2017. The postpartum visit was defined using Healthcare Effectiveness Data and Information Set measures as early care (birth to 21 days) and later care (21-84 days). Anderson's Behavioral Model for Access to Healthcare guided inclusion of potentially predictive factors. We stratified data by postpartum care attendance, and a final predictive model was selected by model fit statistics and clinical relevance. In our sample, 64% of birthing persons attended postpartum care at FQHCs. Of those who returned for care, 38% returned within 21 days postbirth and 62% returned between 21 and 84 days, with 28% returning for both early and later care. Predictors for postpartum care attendance included maternal age, parity, gestational age at first visit, and number of prenatal care visits. A clinical decision support tool for identifying patients less likely to return for care was created. An easy to implement clinical decision support tool can help identify FQHC patients at risk for postpartum nonattendance. Future interventions to improve adequacy of prenatal care can encourage early entry into prenatal care and sufficient prenatal visits. These efforts may improve postpartum care attendance and maternal health.

Perinatal Care Changes During COVID-19: A Population-Based Analysis by Race/Ethnicity

The COVID-19 public health emergency created unprecedented disruptions in the use of healthcare services, which could have affected long-standing racial‒ethnic disparities in maternal care use and outcomes. This study evaluates population-level changes in perinatal health services associated with the COVID-19 pandemic overall and by maternal race‒ethnicity. In this analysis of all U.S. live births from 2016 to 2020, interrupted time-series analysis was used to estimate the change in the mean number of prenatal care visits and rates of hospital birth, labor induction, and cesarean delivery associated with the start of the pandemic (March 2020) overall and by maternal race‒ethnicity. Analyses were conducted in 2022. The start of the pandemic was associated with overall decreases in the mean number of prenatal care visits, decreases in hospital birth rates, and increases in labor induction rates. The mean number of prenatal care visits decreased similarly for all racial‒ethnic groups, whereas reductions in hospital births were largest for non-Hispanic White individuals, and increases in labor induction were largest for non-Hispanic White and non-Hispanic Asian or Pacific Islander individuals. Among all U.S. live births, the COVID-19 pandemic was associated with modest overall changes in perinatal care, with differential changes by maternal race‒ethnicity. Differential changes in perinatal services may have implications for racial-ethnic maternal health disparities.

Advanced maternal age and adverse obstetrical and neonatal outcomes of singleton pregnancies

ObjectiveTo assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies. Study designWe retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas, Iran, from January 2020 to January 2022. Demographic and obstetrical factors include educational level, medical insurance, residency place, access to prenatal care facilities, number of prenatal care visits, smoking status, gestational age, parity, infertility, maternal comorbidities, preeclampsia, eclampsia, preterm birth, low birth weight (LBW), intrauterine growth restriction (IUGR), macrosomia, placenta abnormalities (previa/acreta), placenta abruption, chorioamnionitis, meconium fluid, fetal distress, methods of delivery, rate of cesarean section (CS), perineal lacerations, postpartum hemorrhage, childbirth injury, shoulder dystocia, congenital malformation, neonatal asphyxia, and unfavorable maternal and neonatal outcome were compared between two groups. The Chi-square test assessed the relationship between categorical factors and maternal age groups. The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression. ResultsOf 8354 singleton deliveries, 22.2% belonged to advanced-age mothers. Advanced-age mothers had less education than those aged 20–34 years old. Chronic hypertension, cardiovascular disease, overt diabetes, and thyroid dysfunction were more prevalent among advanced-age mothers. Compared with mothers aged 20–34 years, mothers aged 35 years and higher had a significantly higher risk of gestational diabetes (aOR: 3.18, 95%CI: 1.56–6.95), preeclampsia (aOR: 2.91, 95%CI: 1.35–4.72), placenta abnormalities (aOR: 1.09, 95%CI: 0.77–1.94), CS (aOR: 3.16, 95%CI: 1.51–3.87), postpartum hemorrhage (aOR: 1.94, 95%CI: 1.24–2.61), intensive care unit admission (aOR: 1.36, 95% CI: 1.15–1.99), LBW (aOR: 1.35, 95%CI: 0.97–2.96), preterm birth (aOR: 2.36, 95%CI: 1.65–4.83), stillbirth (aOR: 1.18, 95%CI: 1.01–3.16), and neonatal intensive care admission (aOR: 2.09, 95%CI: 0.73–3.92). According to bivariate regression, the risk of meconium fluid was lower in advanced-age mothers; however, the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid. ConclusionAdvanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes, which persist even after adjusting for several potential confounders.

Household and context-level determinants of birth registration in Sub-Saharan Africa.

While according to the United Nations birth registration is a human right, in sub-Saharan Africa (SSA) only half of new-born children currently have their birth registered. To gain insight into the reasons behind this low registration rate, we study the role of determinants at the household, sub-national regional and country level, using self-reported birth registration data on 358,842 children in 40 SSA countries. While most of the variation in reported birth registration is due to factors at the household level, context factors are found to play an important role as well. At the household level, poverty, low education, restricted autonomy of women, and belonging to a traditional religion are associated with lower odds of being registered. Lack of professional care during pregnancy, delivery, and early life also decrease the odds of being registered. Important factors at the context level are the average number of prenatal care visits in the local area, living in an urban area, the kind of birth registration legislation, decentralization of the registration system, fertility rates, and the number of conflicts. To improve registration, the complex dynamics of these factors at the household and context level have to be taken into account.

Relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes.

The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.

Mapping the Location of Health Centers in Relation to "Maternity Care Deserts": Associations With Utilization of Women's Health Providers and Services.

Background and Objectives:The aim was to explore the association between community health centers’ (CHC) distance to a “maternity care desert” (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors.Measures:Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff.Research Design:Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a “desert” were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234).Results:Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to “deserts” had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care.Conclusions:CHCs located closer to “deserts” and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.

Determinants of institutional delivery in Sub-Saharan Africa: findings from Demographic and Health Survey (2013\u20132017) from nine countries

IntroductionInstitutional delivery is a major concern for a country’s long-term growth. Rapid population development, analphabetism, big families, and a wider range of urban-rural health facilities have had a negative impact on institutional services in Sub-Saharan Africa (SSA) countries. The aim of this study was to look into the factors that influence women’s decision to use an institutional delivery service in SSA.MethodsThe most recent Demographic and Health Survey (DHS), which was conducted in nine countries (Senegal, Ethiopia, Malawi, Rwanda, Tanzania, Zambia, Namibia, Ghana, the Democratic Republic of Congo) was used. The service’s distribution outcome (home delivery or institutional delivery) was used as an outcome predictor. Logistic regression models were used to determine the combination of delivery chances and different covariates.ResultsThe odds ratio of the experience of institutional delivery for women living in rural areas vs urban area was 0.44 (95% confidence interval (CI) 0.41–0.48). Primary educated women were 1.98 (95% CI 1.85–2.12) times more likely to deliver in health institutes than non-educated women, and secondary and higher educated women were 3.17 (95% CI 2.88–3.50) times more likely to deliver in health centers with facilities. Women aged 35–49 years were 1.17 (95% CI 1.05–1.29) times more likely than women aged under 24 years to give birth in health centers. The number of ANC visits: women who visited four or more times were 2.98 (95% CI 2.77–3.22) times, while women who visited three or less times were twice (OR = 2.03; 95% CI 1.88–2.18) more likely to deliver in health institutes. Distance from home to health facility were 1.18 (95% CI 1.11–1.25) times; media exposure had 1.28 (95% CI 1.20–1.36) times more likely than non-media-exposed women to delivery in health institutions.ConclusionsWomen over 24, primary education at least, urban residents, fewer children, never married (living alone), higher number of prenatal care visits, higher economic level, have a possibility of mass-media exposure and live with educated husbands are more likely to provide health care in institutions. Additionally, the distance from home to a health facility is not observed widely as a problem in the preference of place of child delivery. Therefore, due attention needs to be given to address the challenges related to narrowing the gap of urban-rural health facilities, educational level of women improvement, increasing the number of health facilities, and create awareness on the advantage of visiting and giving birth in health facilities.

308 Significant racial/ethnic and sociodemographic disparities in syphilis among US pregnant women

In recent years, there has been an increase in the prevalence of syphilis among pregnant women in the United States (US). We aimed to explore potential racial/ethnic and sociodemographic disparities in the prevalence of syphilis in US pregnancies. We conducted a retrospective analysis of the Centers for Disease Control’s Natality Live Birth database (2016-2018). The prevalence of syphilis was compared among gravidas of different racial/ethnic groups using Pearson’s chi-square test with Bonferroni adjustment. Logistic regression explored the association between syphilis and maternal race/ethnicity, age, education level, type of medical insurance, no or late (≥2nd trimester) prenatal care, total number of prenatal care visits and smoking during pregnancy. Results were displayed as adjusted odds ratios (aOR) and 95% confidence intervals (CI), and statistical significance was set as p-value < 0.05. The cohort included 9,917 live births to women with syphilis during pregnancy (0.10% of the total 10,199,489). Non-Hispanic Blacks had the highest prevalence of syphilis, followed by Hispanics (p<0.001) (Figure). Of the sociodemographic parameters, non-Hispanic Black race and education level less than high school graduation were associated with the highest risk for syphilis in pregnancy (aOR 4.82, 95% CI 4.57-5.08, and OR 4.15, 95% CI 3.59-4.79, respectively). Additional significant risk factors included education level of high school graduation, Medicaid insurance, smoking during pregnancy, maternal age ≥ 40, Hispanic ethnicity, and no prenatal care (Table). We document significant racial/ethnic and sociodemographic disparities in the risk of syphilis in US pregnancies. Most prominently, black race and low education level among other sociodemographic factors were associated with a substantially increased risk for syphilis in pregnancy. These findings suggest that public health initiatives to improve education, prevention, and access to screening and treatment of syphilis, should focus on these vulnerable high-risk populations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors associated with risk of preterm delivery in Tanzania: A case-control study at Muhimbili National Hospital.

To determine factors associated with risk of preterm delivery among pregnant women delivering at Muhimbili National Hospital in Tanzania. A 1:1 case-control study was conducted to assess maternal sociodemographic, lifestyle, and current and previous obstetric factors associated with risk of preterm delivery. Mothers of preterm infants were regarded as cases and those of term infants were controls. Chi-square test and logistic regression were used to assess association between the factors and risk of preterm delivery. A total of 222 case-control pairs were studied. Maternal type of employment (P=0.039), previous preterm delivery (P=0.002), previous spontaneous abortion (P=0.004), uterine scar (P<0.001), parity (P=0.034), number of prenatal care visits (P=0.032), premature rupture of membranes (PROM) (P<0.001), placenta previa (P=0.002), bleeding during second trimester (P=0.004), pre-eclampsia (P<0.001), and maternal anemia (P=0.033) were associated with risk of preterm delivery. The main risk factors associated with preterm delivery included previous preterm delivery (odds ratio [OR] 13.23, 95% confidence interval [CI] 1.72-101.95), placenta previa (OR 12.63, 95% CI 1.63-97.98), and PROM (OR 8.77, 95% CI 1.33-4.60). Close monitoring of pregnant women who present any of the risk factors is important to prevent or reduce the risk of preterm delivery in Tanzania.

The Prevalence of Nonsyndromic Oral Clefts in Twins Compared to Singletons: The Association With Birth Weight.

To examine the prevalence of nonsyndromic oral clefts in twins compared to singletons in the United States and to evaluate the association between birth weight and nonsyndromic oral clefts. A large population-based cross-sectional study was performed using the data from the US National Center for Health Statistics database in 2017. Our sample consisted of 128 310 twins and 3 723 273 singletons. The variables collected were sociodemographic variables, environmental predictors, and clinical measures. Descriptive analysis, bivariate, and multivariate logistic regression were performed. The main outcome variable in our study is nonsyndromic oral clefts. The prevalence of nonsyndromic oral clefts was 5.22 per 10 000 in twins and 5.12 per 10 000 in singletons. Results show no significant risk of nonsyndromic oral clefts in twins compared to singletons (P = .92). There was a significant relationship between birth weight and infant diagnosed with nonsyndromic oral clefts (P = .01). Unadjusted odds ratio for birth weight was 2.52 (95% CI: 2.25-2.82). Adjusted odds for potential confounders such as mother's age, race, mother's education, gender of the infant, APGAR 5-minute score, gestational age, prenatal smoking, number of prenatal care visits, and mother's body mass index were resulted in similar but with a slightly lower odds of 2.11 (95% CI: 1.78-2.50). Compared to singletons, twins did not have higher risk of nonsyndromic oral clefts. Infants with low birth weight were more prone to have nonsyndromic oral clefts.

Factors associated with low birth weight at term: a population-based linkage study of the 100 million Brazilian cohort

BackgroundFactors associated with low birth weight at term (TLBW), a proxy for intrauterine growth restriction (IUGR), are not well-elucidated in socioeconomically vulnerable populations. This study aimed to identify the factors associated with TLBW in impoverished Brazilian women.MethodsRecords in the 100 Million Brazilian Cohort database were linked to those in the National System of Information on Live Births (SINASC) to obtain obstetric, maternal, birth and socioeconomic data between 2001 and 2015. Multivariate logistic regression was performed to investigate associations between variables of exposure and TLBW.ResultsOf 8,768,930 term live births analyzed, 3.7% presented TLBW. The highest odds of TLBW were associated with female newborns (OR: 1.49; 95% CI: 1.47–1.50), whose mothers were black (OR: 1.20; 95% CI: 1.18–1.22), had a low educational level (OR: 1.57; 95% CI: 1.53–1.62), were aged ≥35 years (OR: 1.44; 95% CI: 1.43–1.46), had a low number of prenatal care visits (OR: 2.48; 95% CI: 2.42–2.54) and were primiparous (OR: 1.62; 95% CI: 1.60–1.64). Lower odds of TLBW were found among infants whose mothers lived in the North, Northeast and Center-West regions of Brazil compared to those in the South.ConclusionMultiple aspects were associated with TLBW, highlighting the need to comprehensively examine the mechanisms underlying these factors, especially in more vulnerable Brazilian populations, in order to contribute to the elaboration of health policies and promote better conditions of life for poor and extremely poor mothers and children.

Large for Gestational Age and Risk for Academic Delays and Learning Disabilities: Assessing Modification by Maternal Obesity and Diabetes.

The objective of this study was to examine academic delays for children born large for gestational age (LGA) and assess effect modification by maternal obesity and diabetes and then to characterize risks for LGA for those with a mediating condition. Cohort data were obtained from the New York City Longitudinal Study of Early Development, linking birth and educational records (n = 125,542). Logistic regression was used to compare children born LGA (>90th percentile) to those born appropriate weight (5–89th percentile) for risk of not meeting proficiency on assessments in the third grade and being referred to special education. Among children of women with gestational diabetes, children born LGA had an increased risk of underperforming in mathematics (ARR: 1.18 (95% CI: 1.07–1.31)) and for being referred for special education (ARR: 1.18 (95% CI: 1.02–1.37)). Children born LGA but of women who did not have gestational diabetes had a slightly decreased risk of academic underperformance (mathematics-ARR: 0.94 (95% CI: 0.90–0.97); Language arts-ARR: 0.96 (95% CI: 0.94–0.99)). Children born to women with gestational diabetes with an inadequate number of prenatal care visits were at increased risk of being born LGA, compared to those receiving extensive care (ARR: 1.67 (95% CI: 1.20–2.33)). Children born LGA of women with diabetes were at increased risk of delays; greater utilization of prenatal care among these diabetic women may decrease the incidence of LGA births.

Obstetrical Care Is Associated with Child Dietary Diversity in Indonesia: Analysis from Demographic and Health Survey 2015

Abstract Objectives Our study aimed to examine if obstetrical care factors are associated with dietary diversity score, minimum dietary diversity (4 or more out of 7 food group consumption), and consumption of seven food groups among children ages 6–23 months using the Indonesia Demographic and Health Survey 2015. Methods Univariate and multiple logistic regression were performed to assess the association between obstetrical care factors, including number of prenatal care visits, location of delivery, mode of delivery, delivery provider, timing of postnatal visit, and postnatal visit provider, with dietary diversity score, minimum dietary diversity, and consumption of seven food groups. Results Four or more prenatal care visits, delivery in a health facility, delivery assisted by trained professional, or delivery by C-section were positively associated with higher dietary diversity scores of children (All P &amp;lt; 0.05). Delivery in a health facility and delivery assisted by a health professional was associated with higher odds of minimum dietary diversity (OR = 1.45, 95% CI [1.18–1.79] and OR = 2.10, 95% CI [1.54–2.87]). Four or more prenatal care visits was associated with higher odds of consumption of eggs (OR = 1.28, 95% [1.01–1.63]). Four or more antenatal visits, delivering at a health facility, and having a professional delivery attendant was associated with higher odds of consumption of lentils (OR = 1.66, 95% CI [1.23–2.25], OR = 1.30, 95% CI [1.02–1.65], OR 1.79, 95% CI [1.19–2.69], respectively). Four or more antenatal visits, delivery at a health facility, and having a professional delivery attendant was associated with higher odds of consumption of other fruits and vegetables (OR = 1.70, 95% CI [1.23–2.35), OR = 1.23, 95% CI [1.03–1.61], OR = 1.90, 95% CI [1.29- 2.79]). Having a professional delivery attendant was associated with higher odds of consumption of grains, flesh, and eggs (OR 1.72, 95% CI [1.09– 2.71], OR = 1.67, 95% CI [1.26–2.21], OR = 1.71, 95% CI [1.29–2.24]). Conclusions Obstetrical care received from a health facility and professionally trained providers throughout pregnancy is positively associated with dietary diversity in children ages 6–23 months. Efforts focusing on providing nutritional education before and during birth could be encouraged, especially for mothers seeking care outside of a health facility in Indonesia. Funding Sources None.

The Prevalence of Pregnancy Hypertensive Disorders and Their Related Factors in the Second and Third Level Hospitals Affiliated to Isfahan University of Medical Sciences, Isfahan, Iran

Background & aim: Gestational hypertension is the leading cause of maternal mortality. The most effective ways to prevent this complication are the prediction and prevention of the factors accounting for the incidence of this condition. Regarding this, the present study aimed to investigate the prevalence of gestational hypertension and its associated factors. Methods: This comparative descriptive study was performed on 2,477 pregnant women referred to four secondary and tertiary care hospitals in Isfahan, Iran in 2016 using the census method. Out of 2,477 referral cases, 148 cases were found to be suffering from various types of gestational hypertensive disorders. 200 mothers who had no pregnancy complication were also randomly selected from the 2,477 referral cases. The demographic, clinical, and therapeutic data of these mothers were collected using self-structured questionnaires through making regular visits to the maternity and obstetrics wards of the hospitals under study. Data analysis was performed in SPSS (version 18) using inferential statistical methods, including Chi-square test and independent t-test. Results: The prevalence of hypertension was obtained as 6%, with preeclampsia as the most prevalent type (4.2%). The incidence of gestational hypertension showed a significant relationship with the mean number of prenatal care visits (P=0.01), type of care providers delivering preconception and prenatal care (P=0.01 and p <0.001), underlying diseases (p <0.001), and number of previous abortions (P=0.01). However, there was no significant relationship between the frequency of preconception care visits and this complication (P=0.42). Conclusion: Despite the current policies targeted toward the promotion of maternal health, in the present study, the prevalence of gestational hypertension was notably higher than the rates reported in the literature. Therefore, it is highly recommended to plan for the standardization of referral hospitals and enhancement of care services to prevent this complication.

Differences in Prenatal Care by Presence and Type of Maternal Disability

Prior studies have found that women with disabilities are less likely to receive adequate prenatal care than women without disabilities. However, little is known about differences in patterns of prenatal care by type of disability. Therefore, this study examined timing and frequency of prenatal care among women with physical, sensory, or intellectual/developmental disabilities compared with women without disabilities. This was a retrospective cohort study using linked maternal and infant hospital discharge and birth certificate data for all births in California in 2000-2012 (N=6,745,201). Analyses were conducted in 2017-2018. Modified Poisson regression analyses compared women with each type of disability with women without disabilities on trimester of prenatal care initiation and number of prenatal care visits. Women with intellectual/developmental disabilities or with limited hearing had significantly higher RR of delaying prenatal care initiation until the second or third trimester (intellectual/developmental disabilities: adjusted RR=1.21, 95% CI=1.09, 1.33; hearing: adjusted RR=1.11, 95% CI=1.02, 1.21), whereas women with physical disabilities and limited vision had lower risk of delaying care (physical: adjusted RR=0.91, 95% CI=0.88, 0.94; vision: adjusted RR=0.85, 95% CI=0.73, 0.99). Women with limited hearing or vision or intellectual/developmental disabilities had higher risk of receiving fewer prenatal visits than recommended, compared with women without disabilities. Women with physical disabilities or intellectual/developmental disabilities had higher RR of receiving more than the typical number of visits. There were key differences in prenatal care utilization by disability type, reflective of particularly pronounced disparities for women with intellectual/developmental disabilities and women with limited hearing. Delays in receipt of prenatal care and low numbers of prenatal care visits may contribute to the poorer birth outcomes that have been observed previously in these groups. Targeted interventions are needed to improve uptake of prenatal care in these vulnerable populations.

Improved Value of Individual Prenatal Care for the Interdisciplinary Team.

Objective Innovative models of prenatal care are needed to improve pregnancy outcomes and lower the cost of care. We sought to increase the value of traditional prenatal care by using a new model (PodCare) featuring a standardized visit schedule and coordination of care within small interdisciplinary teams in an academic setting. Methods Prenatal providers and clinic staff were divided into four “Pods”. Testing and counseling topics were assigned to visits based on gestational age. Interdisciplinary weekly Pod meetings provided coordination of care. A retrospective chart review was performed. The primary endpoints were the number of prenatal care visits and number of providers seen. Results After PodCare implementation, more patients choose care with the low-risk physician team (42% compared to 26%). Study subjects included 85 women in 2013 and 165 women in 2014. The median number of visits decreased from 13 to 10 (p < 0.00004) and the median number of providers seen decreased from 7 to 5 (p < 0.0000008). Conclusion PodCare increased the value of individual prenatal care by decreasing the number of visits, increasing continuity, and providing care coordination. The model provides a robust experience in interdisciplinary care. The PodCare model may be successful at other academic institutions.