Association between Prenatal Care Adequacy Indexes and Low Birth Weight Outcome

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Perinatal Medicine

Background:

• Low birth weight (LBW) is a significant global health concern, associated with increased neonatal morbidity and mortality.
• Adequate prenatal care (PNC) is crucial for monitoring maternal and fetal well-being during pregnancy.
• Evaluating the adequacy of PNC services is essential for identifying potential risk factors for adverse birth outcomes.

Purpose of the Study:

• To assess the association between various prenatal care (PNC) adequacy indexes and the incidence of low birth weight (LBW).
• To compare the discriminatory power of different PNC adequacy indexes in predicting LBW.
• To identify key maternal and neonatal factors associated with LBW.

Main Methods:

• Analysis of 368,093 live singleton births in Rio de Janeiro, Brazil (2015-2016) using the Brazilian Live Birth Information System (SINASC).
• Evaluation of seven PNC adequacy indexes, including Brazilian and international measures.
• Multivariate logistic regression models were employed to estimate adjusted odds ratios, controlling for maternal, gestational, and newborn characteristics.

Main Results:

• Inadequate PNC was associated with a 42% to 132% increase in the odds of LBW, varying by the index used.
• Factors such as young maternal age (15-17 years), advanced maternal age (35-45 years), unmarried status, Black/Brown ethnicity, low educational attainment, primiparity, preterm birth, and female newborn sex were linked to higher LBW odds.
• The predictive models achieved an area under the ROC curve between 80.4% and 81.0%, with sensitivity and specificity ranging from 57.7%-58.6% and 94.3%-94.5%, respectively.

Conclusions:

• The Adequacy of Prenatal Care Utilization (APNCU) index exhibited the strongest discriminatory power and predictive ability for LBW outcomes among all evaluated indexes.
• The findings underscore the importance of adequate PNC in preventing LBW and highlight the APNCU index as a valuable tool for assessing PNC quality and predicting risks.