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Am J Perinatol
DOI: 10.1055/a-2295-6524
Original Article

Reevaluating Associations between Prenatal Care Utilization and Current Trends in Preterm Birth

Macie L. Champion 
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Elisa T. Bushman
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Kimberly D. Martin
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
,
Ashley N. Battarbee 
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lindsay S. Robbins
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
William W. Andrews
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. Tita
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract

Objective Studies have suggested an association between prenatal care (PNC) and preterm birth (PTB). We evaluated trends in PTB and association of PNC and PTB.

Study Design This was a retrospective cohort study of singleton, viable nonanomalous deliveries from 1991 to 2018. PNC utilization was defined by World Health Organization using number of visits: adequate (≥8), suboptimal (5–7), and inadequate (<5). Primary outcome was PTB. Tests of trend were used to assess changes in PTB over time. Baseline characteristics and outcomes were compared. Logistic regression estimated the association of PNC and PTB. We evaluated for effect modification by year of birth.

Results Of 92,294 patients, 14,057 (15%) had PTB. Inadequate and suboptimal PNC were associated with higher odds of PTB compared to adequate PNC (adjusted odds ratios [aOR 6.21], 95% confidence interval [CI] 5.84–6.60; aOR 3.57, 95% CI 3.36–3.79). Inadequate PNC was associated with higher odds of PTB over time (effect modification p < 0.0001). Inadequate PNC was associated with 5.4 times higher odds of PTB in 1998, 7.0 times in 2008, and 9.1 times in 2018.

Conclusion Despite an increase in adequate PNC, there was a rise in PTB associated with inadequate and suboptimal PNC. PNC utilization was a stronger risk factor in recent years with higher PTB in patients who attended more than five PNC visits.

Key Points

  • PNC utilization is associated with the risk of PTB.

  • Despite an increase in PNC utilization, PTB rates have increased.

  • There is an even stronger association between PNC utilization and PTB over time.

Keywords

preterm birth - prenatal care - prematurity - social determinants of health


Publication History

Received: 09 November 2023

Accepted: 24 March 2024

Accepted Manuscript online:
27 March 2024

Article published online:
11 April 2024

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  • References

  • 1 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
    Google Scholar
  • 2 CDC. Division of Reproductive Health. Premature Birth. 2020. Accessed at April 1, 2024 at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
  • 3 U.S. Department of Health and Human Services. Maternal, Infant and Child Health. Office of Disease Prevention and Health Promotion. 2020. Accessed April 1, 2024 at: www.healthypeople.gov
  • 4 Leveno KJ, McIntire DD, Bloom SL, Sibley MR, Anderson RJ. Decreased preterm births in an inner-city public hospital. Obstet Gynecol 2009; 113 (03) 578-584
    Google Scholar
  • 5 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61 (04) 344-349
    Google Scholar
  • 6 WHO. WHO recommendations on antenatal care for positive pregnancy experience. 2016. Accessed April 1, 2024 at: http://www.who.int https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1
  • 7 American College of Obstetricians and Gynecologists' Committee on Practice B-O. Prediction and Prevention of Spontaneous Preterm Birth. Prediction and Prevention of Spontaneous Preterm Birth: ACOG Practice Bulletin, Number 234. Obstet Gynecol 2021; 138 (02) e65-e90
    Google Scholar
  • 8 Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA. The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol 2002; 187 (05) 1254-1257
    Google Scholar
  • 9 Krueger PM, Scholl TO. Adequacy of prenatal care and pregnancy outcome. J Am Osteopath Assoc 2000; 100 (08) 485-492
    Google Scholar
  • 10 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84 (09) 1414-1420
    Google Scholar
  • 11 McDuffie Jr RS, Beck A, Bischoff K, Cross J, Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA 1996; 275 (11) 847-851
    Google Scholar