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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
Best Start: Ontario's Maternal Newborn and Early Child Development Resource Centre. Routine Prenatal Care. Toronto. Available at:www.ontarioprenataleducation.ca/routine-prenatal-care/?target=key-messages. Accessed September 4, 2019.
- Beliefs and behaviors of pregnant women with addictions awaiting treatment initiation.Child Adolesc Soc Work J. 2016; 34: 65-79
- Provision of Effective Antenatal Care: Maternal and Neonatal Care Standards Integrated Management of Pregnancy and Childbirth (IMPAC).WHO, Geneva2006 (Available at:)www.who.int/reproductivehealth/publications/maternal_perinatal_health/effective_antenatal_care.pdfDate accessed: November 16, 2018
- Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices.BMC Pregnancy Childbirth. 2008; 8: 15
- Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey.J Perinatol. 2016; 36: 420-426
- Characteristics of women who do not seek prenatal care and implications for prevention.J Obstet. Gynecol Neonatal Nurs. 2009; 38: 174-181
- Social inequalities in use of prenatal care in Manitoba.J Obstet Gynaecol Can. 2007; 29: 806-816
- Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review.Eur J Public Health. 2011; 22: 904-913
- Disposition and health outcomes among infants born to mothers with no prenatal care.Child Abuse Negl. 2009; 33: 116-122
- Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case-control study.BMC Pregnancy Childbirth. 2014; 14: 1-16
- Perceptions of barriers, facilitators and motivators related to use of prenatal care: a qualitative descriptive study of inner-city women in Winnipeg, Canada.SAGE Open Med. 2015; 3205031211562131
- Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years.Am J Perinatol. 2012; 29: 787-793
- Under-attending free antenatal care is associated with adverse pregnancy outcomes.BMC Public Health. 2007; 7: 268
- Adequacy of prenatal care and neonatal mortality in infants born to mothers with and without antenatal high-risk conditions.Aus. N Z J Obstet Gynaecol. 2007; 47: 122-127
Buist S, PECOSKIE T. BORN - Code Red Hamilton. The Hamilton Spectator, 2011. Available at: codered.thespec.io/?page_id=10. Accessed on September 4, 2019.
- Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- A descriptive study of women presenting to an obstetric triage unit with no prenatal care.J Obstet Gynaecol Can. 2014; 36: 216-222
- Psychiatric co-morbidities in pregnant women with opioid use disorders: prevalence, impact, and implications for treatment.Curr Addict Rep. 2017; 4: 1-13
- Maternal mental health after custody loss and death of a child: a retrospective cohort study using linkable administrative data.Can J Psychiatry. 2018; 63: 322-328
- Predictors of having a first child taken into care at birth: a population-based retrospective cohort study.Child Abuse Negl. 2018; 76: 1-9
Giglia LG, Seigel S, Bhardwaj A, et al. Neonatal outcomes of infants born to mothers with limited or no prenatal care., 88th Annu Conf Abstr Can Paediatr Soc Quebec City, QC Canada 2011;16:31A.
- Quantifying the adequacy of prenatal care: a comparison of indices.Public Health Rep. 1996; 111 (discussion 419): 408-418
- WHO recomendations on antenatal care for a positive pregnancy experience.WHO, Geneva2016 (Available at:)www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/Date accessed: August 23, 2019
- Prenatal care reduces the impact of illicit drug use on perinatal outcomes.J Perinatol. 2003; 23: 354-360
Heaman M, Tjaden L. Final Report: Evaluation of the Partners in Inner-City Integrated Prenatal Care (PIIPC) Project, 2017. Available at:www.wrha.mb.ca/community/publichealth/files/PIIPCFINAL.pdf. Accessed on August 23, 2019.
Robertson A, Kinsella E. Caring for women with newborn custodial losses: a literature review. Can J Midwifery Res Pract 2014;1:18–31.
Novac S, Paradis E, Brown J, et al. A visceral grief : young homeless mothers and loss of child custody. Research paper 206. Toronto, Ontario: University of Toronto Centre for Urban and Community Studies; 2006. Available at: www.urbancentre.utoronto.ca/pdfs/elibrary/Novacet-al-206-VisceralGriefHLMothers.pdf. Accessed September 4, 2019.
- The influence of socio-economic status on adverse birth outcomes.Can J Midwifery Pract Res. 2016; 15: 10-20
- Deprivation and poor psychosocial support are key determinants of late antenatal presentation and poor fetal outcomes-a combined retrospective and prospective study.BMC Pregnancy Childbirth. 2015; 15: 309
- Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome.Semin Perinatol. 2017; 41: 308-317
Article info
Publication history
Published online: December 06, 2019
Footnotes
Competing Interests: See Acknowledgements.
The authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
