Prospective Comparative Study on the Relationship Between Adverse Maternal and Fetal Outcomes and the Total Number of Antenatal Visits: Evaluating the Focused Antenatal Care Model and Assessment of Prenatal Care Utilization Index.

Abstract

Objectives: Antenatal care (ANC) visits during pregnancy aim to identify and address factors associated with unsafe pregnancy while educating pregnant women on the nuances of pregnancy and motherhood. The recommended number of visits varies across different countries. We compared the adverse maternal and fetal outcomes in participants with adequate ANC visits to the Focused ANC (FANC) model by the World Health Organization with those in the adequate and adequate plus categories of the Adequacy of the Prenatal Care Utilization (APNCU) index, to evaluate if the number of visits had any influence on these outcomes.

Methods: We conducted a prospective observational study among consenting participants who had received one or more antenatal visits elsewhere before presenting to our hospital for further care between January 2021 and September 2022. We collected details on previous pregnancy, prior ANC visits, adverse maternal, and fetal outcomes after delivery, and then statistically analyzed the data. Categorical variables were analyzed using the chi-square test, and the level of significance was set at p ≤ 0.05 with a confidence interval of 95%.

Results: A total of 500 participants were included. Of these, 2.0%, 13.4%, 46.6%, and 38.0% received adequate plus, adequate, intermediate, and inadequate prenatal care, respectively. There was a statistically significant difference between participants with adequate visits as per the FANC model and those with adequate and adequate plus visits as per the APNCU index in the distribution of high-risk factors in the index pregnancy, such as anemia, hypertensive disorder, and gestational diabetes mellitus. Similarly, statistically significant differences were found between adverse maternal outcomes like post-partum hemorrhage and intensive care unit admission, and adverse neonatal outcomes like preterm birth, low birth weight, birth asphyxia, neonatal hypoglycemia, meconium aspiration, neonatal intensive care unit admission, and stillbirth.

Conclusions: Although the number of participants receiving adequate ANC based on the FANC model was greater than those in the adequate and adequate plus categories according to the APNCU index, the frequency of adverse maternal and fetal outcomes was higher in the FANC model. This most likely indicates that less frequent ANC visits are probably inadequate for the timely identification of issues of concern, and therefore for preventing adverse outcomes.