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The Association of Inadequate and Intensive Prenatal Care With Maternal, Fetal, and Infant Outcomes: A Population-Based Study in Manitoba, Canada

  • Author Footnotes
    ⁎ Deceased.
    Maureen I. Heaman
    Correspondence
    Corresponding author: Dr. Maureen Heaman, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba; Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB.
    Footnotes
    ⁎ Deceased.
    Affiliations
    College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB

    Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
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  • Author Footnotes
    ⁎ Deceased.
    Patricia J. Martens
    Footnotes
    ⁎ Deceased.
    Affiliations
    Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB

    Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
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  • Marni D. Brownell
    Affiliations
    Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB

    Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
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  • Mariette J. Chartier
    Affiliations
    Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB

    Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
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  • Shelley A. Derksen
    Affiliations
    Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
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  • Michael E. Helewa
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
    Search for articles by this author
  • Author Footnotes
    ⁎ Deceased.
Published:January 11, 2019DOI:https://doi.org/10.1016/j.jogc.2018.09.006

      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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