Prenatal Care Utilization Research Articles

Neighborhood risk and prenatal care utilization in Rhode Island, 2005-2014.

The importance of prenatal care is undeniable, as pregnant persons who receive on-time, adequate prenatal care have better maternal and infant health outcomes compared with those receiving late, less than adequate prenatal care. Previous studies assessing the relationship between neighborhood factors and maternal health outcomes have typically looked at singular neighborhood variables and their relationship with maternal health outcomes. In order to examine a greater number of place-based risk factors simultaneously, our analysis used a unique neighborhood risk index to assess the association between cumulative risk and prenatal care utilization, which no other studies have done. Data from Rhode Island Vital Statistics for births between 2005 and 2014 were used to assess the relationship between neighborhood risk and prenatal care utilization using two established indices. We assessed neighborhood risk with an index composed of eight socioeconomic block-group variables. A multivariate logistic regression model was used to examine the association between adequate use and neighborhood risk. Individuals living in a high-risk neighborhood were less likely to have adequate or better prenatal care utilization according to both the APNCU Index (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.87-0.95) and the R-GINDEX (aOR 0.88, 95% CI 0.85-0.91) compared with those in low-risk neighborhoods. Understanding the impact of neighborhood-level factors on prenatal care use is a critical first step in ensuring that underserved neighborhoods are prioritized in interventions aimed at making access to prenatal care more equitable.

Prenatal care utilization and perinatal outcomes among pregnant adolescents in Mexico, 2008-2019.

To describe utilization of prenatal care and outcomes of low birth weight and preterm birth among adolescent births in Mexico. We used birth certificate data and included live births to individuals 10-24 years, 2008-2019. Our outcomes were binary measures of adequate prenatal care, low birth weight, and preterm birth. We compared adolescents (10-14 years, 15-16, and 17-19) to those 20-24 years. We included individual-, clinical-, and municipality-level variables, used multivariable logistic regression, and calculated adjusted predicted probabilities. We also tested whether receipt of prenatal care moderated the relationship of age with preterm birth and low birth weight. We included a total of 12 106 710 births to women 10-24 years. The adjusted predicted probability of adequate prenatal care increased with age: 56.07% (95% CI 55.82-56.31%) adjusted probability among adolescents 10-14 years compared with 65.51% (95% CI 65.48%-65.55%) among individuals 20-24 years. Receipt of adequate prenatal care in part mitigated disparities in preterm birth and low birthweight across all age groups: 7.30% (95% CI 7.17%-7.43%) adjusted probability of delivering a preterm infant among those 10-14 years who received adequate prenatal care compared with 9.37% (95% CI 9.20%-9.53%) among those 10-14 years without adequate prenatal care. In Mexico, adolescent pregnancies are associated with inadequate prenatal care as well as higher odds of preterm delivery and low birth weight. Youngest adolescents (10-14 years) have the highest probability of adverse outcomes. Adequate prenatal care may help partially mitigate disparities in poor perinatal outcomes.

275 The effects of dynamic patient trajectories on prenatal care utilization and clinical operations

275 The effects of dynamic patient trajectories on prenatal care utilization and clinical operations

Patient-reported barriers to prenatal diagnosis of congenital heart defects: A mixed-methods study.

To ascertain patient-reported, modifiable barriers to prenatal diagnosis of congenital heart defects (CHDs). This was a mixed-methods study among caretakers of infants who received congenital heart surgery from 2019 to 2020 in the Chicagoland area. Quantitative variables measuring sociodemographic characteristics and prenatal care utilization, and qualitative data pertaining to patient-reported barriers to prenatal diagnosis were collected from electronic health records and semi-structured phone surveys. Thematic analysis was performed using a convergent parallel approach. In total, 160 caretakers completed the survey, 438 were eligible for survey, and 49 (31%) received prenatal care during the COVID-19 pandemic. When comparing respondents and non-respondents, there was a lower prevalence of maternal Hispanic ethnicity and a higher prevalence of non-English/Spanish-speaking households. Of all respondents, 34% reported an undetected CHD on ultrasound or echocardiogram, while 79% reported at least one barrier to prenatal diagnosis related to social determinants of health. Among those social barriers, the most common were difficulty with appointment scheduling (n=12, 9.5%), far distance to care/lack of access to transportation (n=12, 9.5%) and difficulty getting time off work to attend appointments (n=6, 4.8%). The latter two barriers were correlated. While technical improvements in the detection of CHDs remain an important area of research, it is equally critical to produce evidence for interventions that mitigate barriers to prenatal diagnosis due to social determinants of health.

Influence of Covid-19 Pandemic on Prenatal Care Utilization and Birth outcome - Qualitative Systematic Review Protocol

The COVID pandemic disrupted routine prenatal care, yet little is known about expectant mothers’ experiences during this time. This qualitative systematic review aims to synthesize evidence on the experiences, views and impact of COVID on prenatal care utilization and birth outcomes. A systematic search is conducted in 5 databases and Google Scholar. Studies providing qualitative data on pregnant women’s experiences accessing prenatal care during COVID are included. Methodological quality is assessed using CASP and thematic synthesis is used to analyse the data. Even among these patients from affluent backgrounds, those who responded to the survey stated that the pandemic had significantly disrupted many parts of their daily lives and medical care, especially regarding social activities and postpartum support. Our findings make it clear that, in addition to increased support from healthcare systems, counseling on coping mechanisms and stressor adaptation techniques should be a part of perinatal care during public health emergencies for everyone. Results have provided an in-depth understanding of pregnant women’s experiences with barriers and facilitators to prenatal care during COVID, and the impact on maternal and neonatal outcomes. This review has identified recommendations to improve prenatal care access and quality during future health crises, contributing to more resilient and equitable maternity care systems.

Predictive Ability of Ultrasound on Neonatal Diagnoses and Consequences on Prenatal Care Utilization.

Fetal anomalies suspected on fetal ultrasound may cause significant stress for patients. Some findings resolve or have minimal clinical significance for the neonate. Our purpose is to evaluate fetal ultrasound accuracy and false-positive results and determine the clinical impact on maternal counseling. A retrospective review was performed on electronic medical records for women receiving prenatal care at Harbor-UCLA Medical Center who had abnormal findings on fetal ultrasounds between January 2015 and December 2018. Corresponding neonatal medical records were reviewed for the suspected condition(s). χ2 and Fisher exact tests were conducted to assess associations between fetal ultrasounds and neonatal outcomes. Two hundred eight mothers and 237 babies (including all 29 sets of twins) were included in the final analysis. Fetal ultrasounds were significantly associated with neonatal findings for the following conditions (sensitivity, specificity): anatomical disorder of extremities (0.72, 0.97), anatomical disorder of the face/skull/brain (0.67, 0.91), congenital anomaly of gastrointestinal tract (0.75, 0.98), congenital heart disease (0.75, 0.91), genetic disorder (0.72, 1.00), growth restriction (1.00, 0.85), kidney disorder (0.55, 0.98), and large for gestational age (0.80, 0.98). The highest false-positive rates occurred in congenital heart disease (65.4%), anatomical disorder of the face/skull/brain (64.3%), and growth restriction (54%). Fetal ultrasound highly correlates with neonatal findings for many congenital conditions. However, it can also be associated with a high false-positive rate for certain diagnoses; maternal counseling should include the limitations of ultrasound, including the potential for false-positive results.

Evaluating Standard of Care and Obstetrical Outcomes in a Reduced Contact Prenatal Care Model in the COVID-19 Pandemic.

We aimed to investigate the impact of reduced contact prenatal care necessitated by the COVID-19 pandemic on meeting standards of care and perinatal outcomes. This was a retrospective case-control study of patients in low-risk obstetrics clinic at a tertiary care county facility serving solely publicly insured patients comparing reduced in-person prenatal care (R) over 12 weeks with a control group (C) receiving traditional prenatal care who delivered prior. Total 90 patients in reduced contact (R) cohort were matched with controls (C). There were similar rates of standard prenatal care metrics between groups. Gestational age (GA) of anatomy ultrasound was later in R (p = 0.017). Triage visits and missed appointments were similar, though total number of visits (in-person and telehealth) was higher in R (p = 0.043). R group had higher GA at delivery (p = 0.001). Composite neonatal morbidity and length of stay were lower in R (p = 0.017, p = 0.048). Maternal and neonatal outcomes did not otherwise differ between groups. Using Kotelchuck Adequacy of Prenatal Care Utilization index, R had higher rates of adequate prenatal care (45.6% R vs. 24.4% C, p = 0.005). Our study demonstrates the non-inferiority of a hybrid, reduced schedule prenatal schedule to traditional prenatal scheduling. In a reduced contact prenatal care model, more patients met criteria for adequate prenatal care, likely due to higher attendance of telehealth visits. These findings raise the question of revising the prenatal care model to mitigate disparities in disadvantaged populations.

Association of Antenatal Housing Instability with Perinatal Care Utilization and Outcomes.

Background: Social determinants of health are important contributors to maternal and child health outcomes. Limited existing research examines the relationship between housing instability during pregnancy and perinatal care utilization. Our objective was to evaluate whether antenatal housing instability is associated with differences in perinatal care utilization and outcomes. Materials and Methods: Participants who were surveyed during their postpartum hospitalization were considered to have experienced housing instability if they answered affirmatively to at least one of six screening items. The primary outcome was adequacy of prenatal care measured by the Adequacy of Prenatal Care Utilization index. Maternal, neonatal, and postpartum outcomes, including utilization and breastfeeding, were also collected as secondary outcomes. Multivariable logistic regression models were adjusted for sociodemographic and clinical covariates. Results: In this cohort (N = 490), 11.2% (N = 55) experienced housing instability during pregnancy. Participants with unstable housing were more likely to have inadequate prenatal care (17.3% vs. 3.9%; odds ratio [OR] 5.11, 95% confidence interval [CI] 2.15-12.14, p < 0.001), but findings were not significant after adjustment (aOR 1.72, 95% CI 0.55-5.41, p = 0.35). Similarly, postpartum visit attendance was lower for individuals with unstable housing (79.6% vs. 91.2%), but there was no difference in the odds of the postpartum visit attendance after adjustment (OR 0.69, 95% CI 0.29-1.66, p = 0.14). Conclusions: There were no statistically significant association with the maternal, neonatal, and other postpartum secondary outcomes. Housing instability appears to be a risk marker that is related to other social determinants of health. Given the range of housing instability experiences, future research must account for specific types and degrees of housing instability and their potential perinatal consequences.

Association between language barrier and inadequate prenatal care utilization among migrant women

Abstract Background Language barriers may limit access to care and thus be associated with increased risk of adverse maternal and perinatal outcomes. Our objective is to assess the association between this language barrier and inadequate prenatal care utilization among migrant women. Methods The analysis took place in the French multicentre prospective PreCARE cohort, conducted in four university hospital maternity units in the northern Paris area, having a professional interpreting service. This cohort included 4803 migrant women registered and giving birth between 2010 and 2012. Migrants’ language barrier was categorized in three groups: no, partial or total. Inadequate prenatal care utilization was assessed according to the modified Adequacy of Prenatal Care Utilization Index through multivariable logistic regression models. Results Among the 4803 migrant women included, 16.3% had a partial and 3.8% a total language barrier. Migrants with language barrier had resided less time in France, experienced social deprivation and undocumented status more frequently than those with no language barrier. Compared to migrants with no language barrier, those with partial (RR 1.23, 95%CI 1.13-1.33) and total (RR 1.28, 95%CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity, and region of birth did not modify these association, which were noted particularly among socially deprived women. Conclusions Migrant women with language barrier have a higher risk of inadequate prenatal care utilization than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care. Key messages • Compared with migrant women with no language barrier, those with such barrier, either total or partial, have a higher risk of inadequate prenatal care utilization. • These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.

Rural-urban Disparities in Prenatal Care Utilization: A Study from Khulna District of Bangladesh

This study attempts to identify the nature of prenatal care through a comparative study between urban and rural mothers living in Khulna district of Bangladesh. Two wards in Khulna City Corporation (KCC) and three villages under Rupsha upazila were purposely selected as the study area of this research. The data were collected from 148 mothers selected through simple random sampling method. Findings reveal that medical check-ups during pregnancy were common among most of the respondents (95.9%) in urban areas while it was much less observed among the rural ones (60.8%). Findings also suggest that respondents’ residence was associated with frequency of visiting clinics, taking extra foods during pregnancy and preferred place for medical check-ups during their last pregnancy. Besides, access to reproductive health care services, availability of medical facilities and doctors differed significantly from rural to urban area.

Racial disparities in adequacy of prenatal care during the COVID-19 pandemic in South Carolina, 2018–2021

BackgroundDuring the COVID-19 pandemic, hospitals’ decision of not admitting pregnant women’s partner or support person, and pregnant women’s fear of contracting COVID-19 in hospitals may disrupt prenatal care. We aimed to examine whether prenatal care utilization in South Carolina varied before and during the COVID-19 pandemic, and whether the variation was different by race.MethodsWe utilized 2018–2021 statewide birth certificate data using a pre-post design, including all women who delivered a live birth in South Carolina. The Kotelchuck Index - incorporating the timing of prenatal care initiation and the frequency of gestational age-adjusted visits - was employed to categorize prenatal care into inadequate versus adequate care. Self-reported race includes White, Black, and other race groups. Multiple logistic regression models were used to calculate adjusted odds ratio of inadequate prenatal care and prenatal care initiation after first trimester by maternal race before and during the pandemic.ResultsA total of 118,925 women became pregnant before the pandemic (before March 2020) and 29,237 women during the COVID-19 pandemic (March 2020 – June 2021). Regarding race, 65.2% were White women, 32.0% were Black women and 2.8% were of other races. Lack of adequate prenatal care was more prevalent during the pandemic compared to pre-pandemic (24.1% vs. 21.6%, p < 0.001), so was the percentage of initiating prenatal care after the first trimester (27.2% vs. 25.0%, p < 0.001). The interaction of race and pandemic period on prenatal care adequacy and initiation was significant. The odds of not receiving adequate prenatal care were higher during the pandemic compared to before for Black women (OR 1.26, 95% CI 1.20–1.33) and White women (OR 1.10, 95% CI 1.06–1.15). The odds of initiating prenatal care after the first trimester were higher during the pandemic for Black women (OR 1.18, 95% CI 1.13–1.24) and White women (OR 1.09, 95% CI 1.04–1.13).ConclusionsCompared to pre-pandemic, the odds of not receiving adequate prenatal care in South Carolina was increased by 10% for White women and 26% for Black women during the pandemic, highlighting the needs to develop individual tailored interventions to reverse this trend.

Retrospective Use of Patients' Characteristics to Assess Variation in Prenatal Care Utilization.

We used patients' medical and psychosocial risk factors to explore prenatal care utilization and health outcomes to inform prenatal care tailoring. This retrospective cohort study assessed patients who gave birth at an academic institution from January 1 to December 31, 2018, using electronic health record (EHR) data. Patients were categorized into four phenotypes based on medical/psychosocial risk factors available in the EHR: Completely low risk; High psychosocial risk only; High medical risk only; and Completely high risk. We examined patient characteristics, visit utilization, nonvisit utilization (e.g., phone calls), and outcomes (e.g., preterm birth, preeclampsia) across groups. Of 4,681 patients, the majority were age 18 to 35 (3,697, 79.0%), White (3,326, 70.9%), multiparous (3,263, 69.7%), and Completely high risk (2,752, 58.8%). More Black and Hispanic patients had psychosocial risk factors than White patients. Patients with psychosocial risk factors had fewer prenatal visits (10, interquartile range [IQR]: 8-12) than those without (11, IQR: 9-12). Patients with psychosocial risk factors experienced less time in prenatal care, more phone calls, and fewer EHR messages across the same medical risk group. Rates of preterm birth and gestational hypertension were incrementally higher with additional medical/psychosocial risk factors. Data readily available in the EHR can assess the compounding influence of medical/psychosocial risk factor on patients' care utilization and outcomes. · Medical and psychosocial needs in pregnancy can inform patient phenotypes and are associated with prenatal care use and outcomes.. · Patient phenotypes are associated with prenatal care use and outcomes.. · Patients with high psychosocial risk spent less time in prenatal care and had more phone calls in pregnancy.. · Tailored prenatal care models may proactively address differences in patient's needs..

A Multilevel Decomposition of Time Variation in the Risks of Infant Mortality in Rural Uganda: UDHS 1995–2016

The study assessed the contribution of maternal, child, paternal, household, proximate, and community-level factors to infant mortality risk time variation in rural Uganda between 1995 and 2016. Five rounds of Uganda Demographic and Health Survey data sets were used, and a multilevel mixed-effect logistic regression model was applied to decompose the contribution of different factors to time variation in the risks of infant mortality. All live births that were made five years before the surveys of 1995, 2001, 2006, 2011, and 2016 were considered, with infants who did not survive beyond one year treated as the outcome variable analysis, excluding those who were born less than 12 months before the survey. The fixed part of the model helped us detect the significant variables in determining infant mortality, and yet the random part of the model helped us quantify the amount of time variation in the risks of infant mortality explained by the selected variables. The child-level determinants of infant mortality were sex, birth order, and weight. Among the maternal factors, the study revealed that marital status, access to ANC, use of contraceptives, maternal education level, and preceding birth interval were consistent deterrents of infant mortality, while household size, sanitation, and wealth index remained critical. While controlling for other factors in the rural areas, time variation in the risks of infant mortality was dependent on community factors (such as region, community hygiene, and prenatal care utilization rate), proximate factors (such as access to prenatal care, contraceptives use, place of delivery, and the number of ANC visits), maternal factors (such as marital status, educational level, age, parity, preceding birth interval, desire for pregnancy, and breastfeeding), and endowment. It was observed that the changes in the risks of infant mortality over the period were explained by community (30.7%), proximate (22.7%), maternal (41.0%), and endowment (37.9%). Child-level factors explained 28.2%, and paternal-level education level explained only 30.1%. Remarkably, household-level factors captured 32.3% of the changes in infant mortality. A higher proportion of the explained variation in the risk of infant mortality across communities (PCV) was captured by child, paternal, maternal endowment, and household factors. Interventions to accelerate the reduction in infant mortality should target birth spacing to at least two years, girl child education to at least o level, joint household decision-making in having children, avoiding teenage pregnancies, postnatal care utilization, enforcing at least four ANC visits during pregnancy, improving household sanitation, and increasing access to safe water at household-levels

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest.

Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts. This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community. This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area. FTPNC was challenged by women's immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education. Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.

Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil

BackgroundThe rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU – Adequacy of the prenatal care utilization) index and CS rates.MethodsWe conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014–2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth – either public healthcare or private health insurers – and maternal sociodemographic data.ResultsCS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries.ConclusionAccess to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.

Medicaid expansion and risk of eclampsia

Eclampsia is an indicator of severe maternal morbidity and can be prevented through increased prenatal care access and early prenatal care utilization. The 2014 Medicaid expansion under the Patient Protection and Affordable Care Act allowed states to expand Medicaid coverage to nonelderly adults with incomes up to 138% of the federal poverty level. Its implementation has led to a significant increase in prenatal care access and utilization. This study aimed to assess the association of Medicaid expansion under the Affordable Care Act with eclampsia incidence. This natural experiment study was based on US birth certificate data from January 2010 to December 2018 in 16 states that expanded Medicaid in January 2014 and in 13 states that did not expand Medicaid during the study period. The outcome was eclampsia incidence, the intervention was the implementation of the Medicaid expansion, and the exposure was state expansion status. Using the interrupted time series method, we compared temporal trends in the incidence of eclampsia before and after the intervention in expansion vs non-expansion states with adjustments for patient and hospital county characteristics. Of the 21,570,021 birth certificates analyzed, 11,433,862 (53.0%) were in expansion states and 12,035,159 (55.8%) were in the postintervention period. The diagnosis of eclampsia was recorded in 42,677 birth certificates or 19.8 per 10,000 (95% confidence interval, 19.6-20.0). The incidence of eclampsia was higher for Black people (29.1 per 10,000) than for White (20.7 per 10,000), Hispanic (15.3 per 10,000), and birthing people of other race and ethnicity (15.4 per 10,000). In the expansion states, the incidence of eclampsia increased during the preintervention period and decreased during the postintervention period; in the nonexpansion states, a reverse pattern was observed. A statistically significant difference was observed between expansion and nonexpansion states in temporal trends between the pre- and postintervention periods, with an overall 1.6% decrease (95% confidence interval, 1.3-1.9) in the incidence of eclampsia in expansion states compared with nonexpansion states. The results were consistent in subgroup analyses according to maternal race and ethnicity, education level (less than high school or high school and higher), parity (nulliparous or parous), delivery mode (vaginal or cesarean delivery), and poverty in the residence county (high or low). Implementation of the Affordable Care Act Medicaid expansion was associated with a small statistically significant reduction in the incidence of eclampsia. Its clinical significance and cost-effectiveness remain to be determined.

Association of Sickle Cell Disease With Racial Disparities and Severe Maternal Morbidities in Black Individuals

Little is known about the association between sickle cell disease (SCD) and severe maternal morbidity (SMM). To examine the association of SCD with racial disparities in SMM and with SMM among Black individuals. This cohort study was a retrospective population-based investigation of individuals with and without SCD in 5 states (California [2008-2018], Michigan [2008-2020], Missouri [2008-2014], Pennsylvania [2008-2014], and South Carolina [2008-2020]) delivering a fetal death or live birth. Data were analyzed between July and December 2022. Sickle cell disease identified during the delivery admission by using International Classification of Diseases, Ninth Revision and Tenth Revision codes. The primary outcomes were SMM including and excluding blood transfusions during the delivery hospitalization. Modified Poisson regression was used to estimate risk ratios (RRs) adjusted for birth year, state, insurance type, education, maternal age, Adequacy of Prenatal Care Utilization Index, and obstetric comorbidity index. From a sample of 8 693 616 patients (mean [SD] age, 28.5 [6.1] years), 956 951 were Black individuals (11.0%), of whom 3586 (0.37%) had SCD. Black individuals with SCD vs Black individuals without SCD were more likely to have Medicaid insurance (70.2% vs 64.6%), to have a cesarean delivery (44.6% vs 34.0%), and to reside in South Carolina (25.2% vs 21.5%). Sickle cell disease accounted for 8.9% and for 14.3% of the Black-White disparity in SMM and nontransfusion SMM, respectively. Among Black individuals, SCD complicated 0.37% of the pregnancies but contributed to 4.3% of the SMM cases and to 6.9% of the nontransfusion SMM cases. Among Black individuals with SCD compared with those without, the crude RRs of SMM and nontransfusion SMM during the delivery hospitalization were 11.9 (95% CI, 11.3-12.5) and 19.8 (95% CI, 18.5-21.2), respectively, while the adjusted RRs were 3.8 (95% CI, 3.3-4.5) and 6.5 (95% CI, 5.3-8.0), respectively. The SMM indicators that incurred the highest adjusted RRs included air and thrombotic embolism (4.8; 95% CI, 2.9-7.8), puerperal cerebrovascular disorders (4.7; 95% CI, 3.0-7.4), and blood transfusion (3.7; 95% CI, 3.2-4.3). In this retrospective cohort study, SCD was found to be an important contributor to racial disparities in SMM and was associated with an elevated risk of SMM among Black individuals. Efforts from the research community, policy makers, and funding agencies are needed to advance care among individuals with SCD.

Association between language barrier and inadequate prenatal care utilization among migrant women in the PreCARE prospective cohort study.

Inadequate prenatal care utilization (PCU) is involved in the higher risk of adverse maternal outcomes among migrant vs. native women. Language barrier may be a risk factor for inadequate PCU. We aimed to assess the association between this barrier and inadequate PCU among migrant women. This analysis took place in the French multicentre prospective PreCARE cohort study, conducted in four university hospital maternity units in the northern Paris area. It included 10419 women giving birth between 2010 and 2012. Migrants' language barrier to communication in French were categorized into three groups: migrants with no, partial or total language barrier. Inadequate PCU was assessed by the date prenatal care began, the proportion of recommended prenatal visits completed and ultrasound scans performed. The associations between these language barrier categories and inadequate PCU were tested with multivariable logistic regression models. Among the 4803 migrant women included, the language barrier was partial for 785 (16.3%) and total for 181 (3.8%). Compared to migrants with no language barrier, those with partial [risk ratio (RR) 1.23, 95% confidence interval (CI) 1.13-1.33] and total (RR 1.28, 95% CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity and region of birth did not modify these associations, which were noted particularly among socially deprived women. Migrant women with language barrier have a higher risk of inadequate PCU than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.

Changes in birth outcomes and utilization of prenatal care during the COVID-19 pandemic in 2020: a secondary analysis of vital statistics in Colombia

BackgroundBirth outcomes could have been affected by the COVID-19 pandemic through changes in access to prenatal services and other pathways. The aim of this study was to examine the effects of the COVID-19 pandemic on fetal death, birth weight, gestational age, number of prenatal visits, and caesarean delivery in 2020 in Colombia.MethodsWe conducted a secondary analysis of data on 3,140,010 pregnancies and 2,993,534 live births from population-based birth certificate and fetal death certificate records in Colombia between 2016 and 2020. Outcomes were compared separately for each month during 2020 with the same month in 2019 and pre-pandemic trends were examined in regression models controlling for maternal age, educational level, marital status, type of health insurance, place of residence (urban/rural), municipality of birth, and the number of pregnancies the mother has had before last pregnancy.ResultsWe found some evidence for a decline in miscarriage risk in some months after the pandemic start, while there was an apparent lagging increase in stillbirth risk, although not statistically significant after correction for multiple comparisons. Birth weight increased during the onset of the pandemic, a change that does not appear to be driven by pre-pandemic trends. Specifically, mean birth weight was higher in 2020 than 2019 for births in April through December by about 12 to 21 g (p < 0.01). There was also a lower risk of gestational age at/below 37 weeks in 2020 for two months following the pandemic (April, June), but a higher risk in October. Finally, there was a decline in prenatal visits in 2020 especially in June-October, but no evidence of a change in C-section delivery.ConclusionsThe study findings suggest mixed early effects of the pandemic on perinatal outcomes and prenatal care utilization in Colombia. While there was a significant decline in prenatal visits, other factors may have had counter effects on perinatal health including an increase in birth weight on average.

The Effect of Prenatal Care on Preterm Birth in a Low-Income Minority Population in DC [ID: 1378551

INTRODUCTION: Structural and social barriers to health care affect prenatal care (PNC) utilization among underrepresented minorities in the District of Columbia (DC) and contribute to preterm birth (PTB) disparities. The PTB rate among Black people in DC was 13.1% (2018–2020), higher than the overall DC (9.8%, 2020) and United States (10.1%, 2020) rates. We evaluated the association between prenatal care utilization and preterm birth in a low-income minority population in DC. METHODS: As part of a collaborative effort with DC Health to reduce PTB, we designed a REDCap database to collect pregnancy and delivery data on all inpatient and outpatient patients at Howard University Hospital (HUH), between January 2020 and September 2022. Our primary exposure variable was PNC (yes or no). Our outcome was PTB (gestational age &lt; or ≥37 weeks). Crude and adjusted logistic regression models analyzed the relationship between prenatal care and preterm birth. RESULTS: A total of 1,382 patient charts were evaluated, of which 11.6% had PTB and 95.1% had any PNC. Majority were Black (55.6%) or Hispanic (42.8%), and had Medicaid (92.2%). Any PNC was associated with a 54% reduced odds of PTB (adjusted odds ratio 0.46, 95% CI 0.22–0.97). Additionally, history of preeclampsia (3.75, 2.51–5.62) or spontaneous PTB (2.51, 1.50–4.18) were significantly associated with PTB. CONCLUSION: Prenatal care usage was associated with reduced odds of preterm birth in our population. Identifying and addressing barriers to prenatal care utilization may improve preterm birth rates among risk-entrenched patients at HUH.