Expecting a Baby? Expect Regular Visits

Prenatal care access linked to infant mortality

(RxWiki News) It can be tempting to skip out on doctor's appointments occasionally to save money in health costs. When pregnant, however, women should think twice before skipping a prenatal visit.

A recent study found that fewer prenatal visits among women in developing countries appeared linked to a higher rate of newborn death.

The study's finding may not relate exactly to women's experiences in developed countries. There is a lower rate of infant death from pregnancies in developed countries than in developing countries.

However, the study shows some evidence to support the importance of attending all recommended prenatal visits.

"Attend all prenatal visits."

The study, led by Joshua P. Vogel, MBBS, of the Faculty of Medicine in Dentistry and Health Sciences at the University of Western Australia, re-evaluated the findings of a trial conducted in 2001 by the World Health Organization.

The conclusion of the original study was that just four total prenatal visits for low-risk pregnant women across the world was no worse than standard prenatal care in local regions, which usually involves more than four visits.

"In the [first] study, women received just 4 prenatal visits during the pregnancy in an attempt to decrease costs," said Allison Hill, an OB/GYN at Good Samaritan Hospital in Los Angeles who was not associated with either study.

This finding meant an opportunity to save health costs without costing lives, the researchers concluded at that time.

However, then a review of three randomized trials in 2010 found a slightly higher risk of death among women in developing countries who had less prenatal care.

Therefore, researchers re-examined the data in the original WHO trial.

The trial involved 12,568 women who received four prenatal visits at 27 clinics across the world. Their outcomes were compared to the 11,958 women who received standard care at one of 26 clinics.

Across the full group, 6,160 women were high risk and 18,365 women were low risk.

Among the women who had only four prenatal visits, 161 of their newborns died, which equaled 1.4 percent of all the children born.

Among the women receiving usual care at their clinics with more prenatal visits, 119 newborns died, for a rate of 1.1 percent.

Then the researchers looked specifically at women's pregnancies between 32 and 36 weeks. They found that women in the group with fewer prenatal visits were twice as likely to lose their babies in those final weeks of pregnancy.

When this finding was factored into the overall analysis, the researchers found that women not going to at least four prenatal visits while pregnant were about 27 percent more likely to lose their baby.

The higher risk of losing a baby in those last several weeks of pregnancy among women with fewer prenatal visits was present for both high risk and low risk pregnant women.

The authors were unable to conclude that the higher risk of losing a baby in those last several weeks was due to less care, though.

"The study shows that there is an increased risk of fetal death for the women who only had four visits," Dr. Hill said. "However, the researchers admit that there are many factors involved in fetal death and there is no way to know if the decreased number of prenatal visits was really a contributing factor."

The differences across the clinics, the women themselves and the overall quality of their care could all play a part. It is difficult to calculate all these factors into the final analysis.

Therefore, the researchers could only say health providers should carefully watch the outcomes of pregnant women and their babies if the health officials implement programs with fewer prenatal visits.

For patients, this finding means that following the recommendations of your health officials and doctors is important to the health of your baby and yourself.

The study was published April 12 in the journal Reproductive Health. The research was funded by the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction of WHO.

Additional support was provided by the Municipal Government of the City of Rosario, Argentina; the Cuban Ministry of Health; the National Institute of Public Health in Mexico; The Population Council—Regional Office for Latin America and the Caribbean; the Ministry of Health in Saudi Arabia; the Swedish Agency for Research Cooperation with Developing Countries; the Ministry of Public Health and Faculty of Medicine at Khon Kaen University in Thailand; the Department for International Development in the UK; Mother Care—John Snow Inc; the National Institute for Child Health and Human Development at the National Institutes of Health in the US; The World Bank; the University of Western Ontario in Canada; the National Institute of Public Health in Norway; the United Nations Development Programme; and the University of Uppsala in Sweden.

Several of the authors were also part of the original WHO study. No other competing interests were noted.

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Review Date: 
April 23, 2013