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Sociodemographic Characteristics and Clinical Outcomes of People Receiving Inadequate Prenatal Care: A Retrospective Cohort Study

Published:December 06, 2019DOI:https://doi.org/10.1016/j.jogc.2019.08.005

      Abstract

      Objective

      This study sought to describe the incidence inadequate prenatal care (IPNC) at an urban level II hospital in Hamilton, Ontario, and to compare the characteristics and outcomes of mothers who received IPNC and their newborns with those who received adequate prenatal care (APNC). This study is the first part of a mixed-methods research program aimed at informing the development of an interdisciplinary, patient-centred, prenatal care program for people who struggle to access conventional modes of care.

      Methods

      This retrospective cohort study compared mothers and neonates born at St. Joseph's Health Care Hamilton in 2016 with IPNC (fewer than or equal to four antenatal visits, or first visit in third trimester) with those born with APNC (five or more prenatal visits and initial visit before the third trimester). Cases and controls matched 3:1 for age and parity were identified through a retrospective chart review.

      Results

      In total 3235 charts were reviewed, and 69 cases of IPNC were identified (2.1%). The IPNC group had lower education and higher unemployment levels, as well as higher rates of smoking and drug use. Our primary and secondary outcomes of newborn custody loss, neonatal intensive care unit admission, and neonatal length of stay were significantly higher in the IPNC group.

      Conclusion

      Patients delivering with IPNC represent a high-risk group with increased rates of adverse neonatal outcomes and newborn custody loss. This quantitative study will inform future research and innovative interdisciplinary program development aimed at increasing access to prenatal care in an effort to improve maternal and neonatal outcomes.

      Résumé

      Objectif

      Les auteurs de l'étude cherchaient à décrire le nombre de cas de patientes au suivi prénatal insuffisant (SPNI) pour un hôpital de niveau II en milieu urbain à Hamilton, en Ontario, et à comparer les caractéristiques et les issues des mères et nouveau-nés concernés avec les mères et nouveau-nés au suivi prénatal adéquat (SPNA). Cette étude est la première partie d'un programme de recherche à méthodes mixtes visant à étayer la conception d'un programme de soins prénataux interdisciplinaires centrés sur la patiente pour celles qui éprouvent des difficultés d'accès aux modes de soins traditionnels.

      Méthodologie

      Dans cette étude de cohorte rétrospective, les auteurs ont comparé les mères et nouveau-nés au SPNI (4 visites prénatales ou moins, ou première visite au troisième trimestre) dont l'accouchement a eu lieu au St. Joseph's Healthcare Hamilton en 2016 avec les mères et nouveau-nés au SPNA (5 visites prénatales ou plus et première visite avant le troisième trimestre). On a déterminé les cas et les témoins à partir d'une revue rétrospective des dossiers avec un appariement 3:1 pour l'âge et la parité.

      Résultats

      Au total, 3 235 dossiers ont été revus et 69 cas de SPNI ont été relevés (2,1 %). Par rapport au groupe de SPNA, les femmes du groupe de SPNI présentaient des niveaux de scolarisation et d'emploi plus faibles en plus d'avoir un taux plus élevé de tabagisme et de consommation de drogues. Les critères de jugement principal et secondaire, dont la perte de la garde du nouveau-né, l'admission à l'unité de soins intensifs néonatale et la durée du séjour du nouveau-né, étaient significativement plus élevés dans le groupe de SPNI.

      Conclusion

      Les patientes qui accouchent en ayant eu un SPNI représentent un groupe à risque élevé qui présente une augmentation des taux d'issues néonatales défavorables et de pertes de la garde du nouveau-né. Cette étude quantitative étayera d'autres recherches et la création de programme interdisciplinaire innovateur visant à améliorer l'accès aux soins prénataux, dans un effort d'amélioration des issues maternelles et néonatales.

      Keywords

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