The association of Chinese and American antenatal care utilization indices with birth outcomes

TL;DR

This study compares Chinese and American prenatal care indices and finds that inadequate care increases risks of preterm birth and low birth weight.

Contribution

The study introduces a comparison of Chinese and American prenatal care indices and their impact on birth outcomes.

Findings

Inadequate prenatal care increases odds of preterm birth and delivering small for gestational age infants.

Crossover analysis shows APNCU inadequacy has the highest risk for preterm birth.

APNCU is suggested as a better tool for evaluating prenatal care use.

Abstract

Few comparisons have been implemented between different prenatal care utilization indices and their effects on adverse outcomes. This study investigated the appropriateness of Chinese antenatal care (ANC) regulations and compared Chinese and American adequacy of prenatal care utilization (APNCU) scores.

From 2010 to 2022, the medical records of 60,114 pregnant women were collected from the electronic medical record system (EMRS) in Zhoushan, China. ANC utilization was measured using the APNCU score and five times antenatal care (ANC5). Birth weight outcomes, including small for gestational age (SGA) and large for gestational age (LGA), low birth weight (LBW), macrosomia, birth weight, and preterm birth (PTB), were utilized as outcomes. Multinomial, linear, and logistic regression were used to analyze the association of ANC5 and APNCU with outcomes, respectively. Crossover analysis was implemented to compare the interaction between ANC5 and APNCU on the outcomes.

Women who received inadequate prenatal care had increased odds for PTB (ANC5: odds ratio (OR) = 1.12, 95% confidence interval (95%CI) = 1.03–1.21; APNCU: OR = 1.18, 95%CI: 1.07–1.29), delivering SGA infants (ANC5: OR = 1.13, 95%CI = 1.07–1.21; APNCU: OR = 1.11, 95%CI = 1.03–1.20). Crossover analysis revealed that inadequate prenatal care in APNCU only was significantly associated with an increased risk of PTB (OR = 1.48, 95%CI: 1.26–1.73).

Women with inadequate prenatal care in ANC5 or APNCU were more likely to suffer from adverse birth outcomes, including PTB, birth weight loss, SGA, and LBW. It indicated that adequate prenatal care is necessary for pregnant women. However, there were interactions between ANC5 and APNCU on PTB, with inadequate prenatal care use by APNCU showing the highest risk of PTB. This indicates that APNCU would be a better tool for evaluating prenatal care use.