Evaluating Risk-Adjusted Associations between Prenatal Care Utilization and Obstetric Outcomes in a Commercially...

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Public Health

Background:

• Traditional office-based prenatal care has remained unchanged for a century.
• The impact of routine antenatal visits on major adverse maternal outcomes is not well understood.
• This study investigates the association between prenatal care utilization and adverse obstetric outcomes.

Purpose of the Study:

• To examine the relationship between prenatal care utilization and severe maternal morbidity (SMM), preterm birth, and stillbirth.
• To assess if the quantity of prenatal care influences these adverse obstetric outcomes.
• To inform clinical quality improvement and health policy regarding prenatal care metrics.

Main Methods:

• Retrospective cohort study using a large US insurance claims database (2017-2020).
• Prenatal care utilization assessed using the Adequacy of Prenatal Care Utilization (APNCU) index.
• Logistic regression models used to analyze associations between care levels and outcomes in low- and medium-risk maternal groups defined by OB-CMI scores.

Main Results:

• No statistically significant association found between prenatal care volume and severe maternal morbidity or stillbirth.
• Preterm birth (<37 weeks) showed a positive association with "adequate" and "adequate plus" care in low- and medium-risk groups.
• "Inadequate" prenatal care was not associated with any of the studied adverse outcomes.
• A total of 297,453 patients were included in the analysis.

Conclusions:

• The overall volume of prenatal care did not demonstrate a reduction in severe maternal morbidity or stillbirth.
• Findings suggest that current prenatal care guidelines focusing on visit numbers may need revision.
• Future efforts should prioritize clinical outcomes over adherence to visit-based metrics for improving prenatal care delivery.