Abstract
Objective
Little is known about how prenatal care influences health outcomes in Canada. The
objective of this study was to examine the association of prenatal care utilization
with maternal, fetal, and infant outcomes in Manitoba.
Methods
This retrospective cohort study conducted at the Manitoba Centre for Health Policy
investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076).
The proportion of women receiving inadequate, intermediate/adequate, and intensive
prenatal care was calculated. Multivariable logistic regression was used to examine
the association of inadequate and intensive prenatal care with maternal and fetal-infant
health outcomes, health care use, and maternal health-related behaviours.
Results
The distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate,
and 4.0% intensive. After adjusting for sociodemographic factors and maternal health
conditions, inadequate prenatal care was associated with increased odds of stillbirth,
preterm birth, low birth weight, small for gestational age (SGA), admission to the
NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to
next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding
or having their infant immunized. Intensive prenatal care was associated with reduced
odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum
depressive/anxiety disorders, initiation of breastfeeding, and infant immunization.
Conclusion
Inadequate prenatal care was associated with increased odds of several adverse pregnancy
outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal
care was associated with reduced odds of some adverse pregnancy outcomes and higher
likelihood of health-related behaviours. Ensuring women receive adequate prenatal
care may improve pregnancy outcomes.
Résumé
Objectif
On sait peu de choses sur l'incidence des soins prénataux sur les issues de santé
au Canada. L'objectif de cette étude était d'examiner le lien entre les soins prénataux
et les issues maternelles, fœtales et infantiles au Manitoba.
Méthodologie
Dans cette étude de cohorte rétrospective menée au Centre d'élaboration de la politique
des soins de santé du Manitoba, nous avons examiné toutes les naissances uniques survenues
entre les années 2004-2005 et 2008-2009 (N = 67 076). Nous avons calculé la proportion
de femmes ayant re¸u des soins prénataux inadéquats, intermédiaires/adéquats et intensifs.
Puis nous avons examiné, par régression logistique multivariée, le lien entre les
soins prénataux inadéquats et intensifs et les issues de santé maternelles et fœtales/infantiles,
l'utilisation des soins de santé et les comportements liés à la santé de la mère.
Résultats
Les soins prénataux étaient inadéquats dans 11,6 % des cas, intermédiaires/adéquats
dans 84,4 % des cas, et intensifs pour les 4,0 % restants. Une fois les facteurs sociodémographiques
et l'état de santé de la mère pris en compte, les soins prénataux inadéquats étaient
associés à un risque accru de mortinaissance, de prématurité, de poids insuffisant
à la naissance, de petite taille pour l'âge gestationnel, d'admission en UNSI, de
troubles anxieux ou dépressifs en période postpartum et d'intervalle intergravidique
court, ainsi qu'à un taux inférieur d'allaitement maternel et d'immunisation du nouveau-né.
Quant aux soins prénataux intensifs, ils étaient associés à un risque de mortinaissance,
de prématurité et de poids insuffisant à la naissance moindre, à un risque accru de
troubles anxieux ou dépressifs en période postpartum et à un taux supérieur d'allaitement
maternel et d'immunisation du nouveau-né.
Conclusion
Les soins prénataux inadéquats semblent associés à un risque accru d'issues défavorables
de la grossesse et à des comportements liés à la santé moins fréquents, alors que
les soins prénataux intensifs semblent associés à une réduction du risque pour certaines
issues défavorables de la grossesse et à des comportements liés à la santé plus fréquents.
Ainsi, veiller à ce que les femmes re¸oivent des soins prénataux adéquats pourrait
améliorer les issues de grossesse.
Key Words
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Article info
Publication history
Published online: January 11, 2019
Accepted:
September 5,
2018
Received:
July 5,
2018
Footnotes
Competing interests: See Acknowledgements.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
