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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Aug;52(8):501–506. doi: 10.1136/jech.52.8.501

Poor antenatal care in 20 French districts: risk factors and pregnancy outcome

B Blondel, B Marshall
PMCID: PMC1756747  PMID: 9876361

Abstract

STUDY OBJECTIVE: Poor attendance to antenatal visits was studied to identify risk factors and to analyse the association with adverse pregnancy outcome. DESIGN: All poor attenders and a sample of good attenders were compared within three groups of women: women < 20 years, French women > or = 20 years, and foreigners > or = 20 years. SETTING: 20 French districts including 85,000 births from January to June 1993. SUBJECTS: 848 poor attenders and 759 good attenders. Poor attenders made fewer than four antenatal visits or began care during or after the sixth month. Good attenders made at least four visits and began care before the sixth month. MAIN RESULTS: 1.1% of the women were poor attenders. Risk factors for poor attendance were single status and lack of health insurance in the group under 20; young age, high parity, and single status in the French group aged over 20; and single status and lack of health insurance in the foreign group aged over 20. For poor attenders, the odds ratios for preterm delivery were 5.8 (95% CI: 3.2, 10.5) among French women and 3.3 (95% CI: 1.5, 7.4) among foreign women with health insurance. Poor attendance was not associated with poor pregnancy outcome in the group under 20, and among foreign women over 20 without health insurance, but both groups had high rates of preterm delivery and low birth weight. CONCLUSION: Lack of health insurance is an important barrier to health care during pregnancy. Poor antenatal care is an important risk factor for adverse pregnancy outcome among women who have easy access to health care services.

 

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Selected References

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  1. Backe B., Nakling J. Effectiveness of antenatal care: a population based study. Br J Obstet Gynaecol. 1993 Aug;100(8):727–732. doi: 10.1111/j.1471-0528.1993.tb14263.x. [DOI] [PubMed] [Google Scholar]
  2. Binsacca D. B., Ellis J., Martin D. G., Petitti D. B. Factors associated with low birthweight in an inner-city population: the role of financial problems. Am J Public Health. 1987 Apr;77(4):505–506. doi: 10.2105/ajph.77.4.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blondel B., Bréart G., du Mazaubrun C., Badeyan G., Wcislo M., Lordier A., Matet N. La situation périnatale en France. Evolution entre 1981 et 1995. J Gynecol Obstet Biol Reprod (Paris) 1997;26(8):770–780. [PubMed] [Google Scholar]
  4. Blondel B., Dutilh P., Delour M., Uzan S. Poor antenatal care and pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 1993 Aug;50(3):191–196. doi: 10.1016/0028-2243(93)90200-v. [DOI] [PubMed] [Google Scholar]
  5. Blondel B., Pusch D., Schmidt E. Some characteristics of antenatal care in 13 European countries. Br J Obstet Gynaecol. 1985 Jun;92(6):565–568. doi: 10.1111/j.1471-0528.1985.tb01393.x. [DOI] [PubMed] [Google Scholar]
  6. Blondel B. Utilité du suivi des grossesses. Risques des grossesses peu ou pas suivies. Presse Med. 1995 Jun 17;24(22):1015–1016. [PubMed] [Google Scholar]
  7. Coburn A. F., McDonald T. P. The effects of variations in AFDC and Medicaid eligibility on prenatal care use. Soc Sci Med. 1992 Oct;35(8):1055–1063. doi: 10.1016/0277-9536(92)90245-l. [DOI] [PubMed] [Google Scholar]
  8. Cooney J. P. What determines the start of prenatal care? Prenatal care, insurance, and education. Med Care. 1985 Aug;23(8):986–997. doi: 10.1097/00005650-198508000-00006. [DOI] [PubMed] [Google Scholar]
  9. Delgado-Rodríguez M., Gómez-Olmedo M., Bueno-Cavanillas A., Gálvez-Vargas R. A comparison of two indices of adequacy of prenatal care utilization. Epidemiology. 1996 Nov;7(6):648–650. doi: 10.1097/00001648-199611000-00016. [DOI] [PubMed] [Google Scholar]
  10. Donaldson P. J., Billy J. O. The impact of prenatal care on birth weight. Evidence from an international data set. Med Care. 1984 Feb;22(2):177–188. doi: 10.1097/00005650-198402000-00009. [DOI] [PubMed] [Google Scholar]
  11. Eisner V., Brazie J. V., Pratt M. W., Hexter A. C. The risk of low birthweight. Am J Public Health. 1979 Sep;69(9):887–893. doi: 10.2105/ajph.69.9.887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Florey C. D., Taylor D. J. The relation between antenatal care and birth weight. Rev Epidemiol Sante Publique. 1994;42(3):191–197. [PubMed] [Google Scholar]
  13. Gissler M., Hemminki E. Amount of antenatal care and infant outcome. Eur J Obstet Gynecol Reprod Biol. 1994 Jul;56(1):9–14. doi: 10.1016/0028-2243(94)90146-5. [DOI] [PubMed] [Google Scholar]
  14. Goldenberg R. L., Patterson E. T., Freese M. P. Maternal demographic, situational and psychosocial factors and their relationship to enrollment in prenatal care: a review of the literature. Women Health. 1992;19(2-3):133–151. doi: 10.1300/J013v19n02_08. [DOI] [PubMed] [Google Scholar]
  15. Gortmaker S. L. The effects of prenatal care upon the health of the newborn. Am J Public Health. 1979 Jul;69(7):653–660. doi: 10.2105/ajph.69.7.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gould J. B., LeRoy S. Socioeconomic status and low birth weight: a racial comparison. Pediatrics. 1988 Dec;82(6):896–904. [PubMed] [Google Scholar]
  17. Greenberg R. S. The impact of prenatal care in different social groups. Am J Obstet Gynecol. 1983 Apr 1;145(7):797–801. doi: 10.1016/0002-9378(83)90681-6. [DOI] [PubMed] [Google Scholar]
  18. Hall M. H., Chng P. K., MacGillivray I. Is routine antenatal care worth while? Lancet. 1980 Jul 12;2(8185):78–80. doi: 10.1016/s0140-6736(80)92950-5. [DOI] [PubMed] [Google Scholar]
  19. Hedegaard M., Henriksen T. B., Sabroe S., Secher N. J. Psychological distress in pregnancy and preterm delivery. BMJ. 1993 Jul 24;307(6898):234–239. doi: 10.1136/bmj.307.6898.234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hoffman S., Hatch M. C. Stress, social support and pregnancy outcome: a reassessment based on recent research. Paediatr Perinat Epidemiol. 1996 Oct;10(4):380–405. doi: 10.1111/j.1365-3016.1996.tb00063.x. [DOI] [PubMed] [Google Scholar]
  21. Insler V., Larholt K., Hagay Z. J., Baly R., Bar-David G., Meizner I., Karplus M., Stone D. The impact of prenatal care on the outcome of pregnancy. Eur J Obstet Gynecol Reprod Biol. 1986 Nov;23(3-4):211–223. doi: 10.1016/0028-2243(86)90150-4. [DOI] [PubMed] [Google Scholar]
  22. Kaunitz A. M., Spence C., Danielson T. S., Rochat R. W., Grimes D. A. Perinatal and maternal mortality in a religious group avoiding obstetric care. Am J Obstet Gynecol. 1984 Dec 1;150(7):826–831. doi: 10.1016/0002-9378(84)90457-5. [DOI] [PubMed] [Google Scholar]
  23. Keeping J. D., Chang A. M., Morrison J., Esler E. J. Poor antenatal attendance and obstetric performance. Aust N Z J Obstet Gynaecol. 1980 Aug;20(3):139–143. doi: 10.1111/j.1479-828x.1980.tb02892.x. [DOI] [PubMed] [Google Scholar]
  24. Kotelchuck M. The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight. Am J Public Health. 1994 Sep;84(9):1486–1489. doi: 10.2105/ajph.84.9.1486. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Krieger J. W., Connell F. A., LoGerfo J. P. Medicaid prenatal care: a comparison of use and outcomes in fee-for-service and managed care. Am J Public Health. 1992 Feb;82(2):185–190. doi: 10.2105/ajph.82.2.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Leveno K. J., Cunningham F. G., Roark M. L., Nelson S. D., Williams M. L. Prenatal care and the low birth weight infant. Obstet Gynecol. 1985 Nov;66(5):599–605. [PubMed] [Google Scholar]
  27. Lia-Hoagberg B., Rode P., Skovholt C. J., Oberg C. N., Berg C., Mullett S., Choi T. Barriers and motivators to prenatal care among low-income women. Soc Sci Med. 1990;30(4):487–495. doi: 10.1016/0277-9536(90)90351-r. [DOI] [PubMed] [Google Scholar]
  28. Mamelle N., Measson A., Munoz F., Audras de la Bastie M., Gerin P., Hanauer M. T., Collet P., Guyotat J. Development and use of a self-administered questionnaire for assessment of psychologic attitudes toward pregnancy and their relation to a subsequent premature birth. Am J Epidemiol. 1989 Nov;130(5):989–998. doi: 10.1093/oxfordjournals.aje.a115432. [DOI] [PubMed] [Google Scholar]
  29. McDuffie R. S., Jr, 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 Mar 20;275(11):847–851. [PubMed] [Google Scholar]
  30. Moore T. R., Origel W., Key T. C., Resnik R. The perinatal and economic impact of prenatal care in a low-socioeconomic population. Am J Obstet Gynecol. 1986 Jan;154(1):29–33. doi: 10.1016/0002-9378(86)90387-x. [DOI] [PubMed] [Google Scholar]
  31. Munjanja S. P., Lindmark G., Nyström L. Randomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe. Lancet. 1996 Aug 10;348(9024):364–369. doi: 10.1016/s0140-6736(96)01250-0. [DOI] [PubMed] [Google Scholar]
  32. Norbeck J. S., DeJoseph J. F., Smith R. T. A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women. Soc Sci Med. 1996 Sep;43(6):947–954. doi: 10.1016/0277-9536(96)00003-2. [DOI] [PubMed] [Google Scholar]
  33. Petitti D., Coleman C., Binsacca D., Allen B. Early prenatal care in urban black and white women. Birth. 1990 Mar;17(1):1–5. doi: 10.1111/j.1523-536x.1990.tb00001.x. [DOI] [PubMed] [Google Scholar]
  34. Rothberg A. D., Lits B. Psychosocial support for maternal stress during pregnancy: effect on birth weight. Am J Obstet Gynecol. 1991 Aug;165(2):403–407. doi: 10.1016/0002-9378(91)90103-x. [DOI] [PubMed] [Google Scholar]
  35. Ryan G. M., Jr, Sweeney P. J., Solola A. S. Prenatal care and pregnancy outcome. Am J Obstet Gynecol. 1980 Aug 15;137(8):876–881. doi: 10.1016/s0002-9378(16)32826-5. [DOI] [PubMed] [Google Scholar]
  36. Sable M. R., Stockbauer J. W., Schramm W. F., Land G. H. Differentiating the barriers to adequate prenatal care in Missouri, 1987-88. Public Health Rep. 1990 Nov-Dec;105(6):549–555. [PMC free article] [PubMed] [Google Scholar]
  37. Sikorski J., Wilson J., Clement S., Das S., Smeeton N. A randomised controlled trial comparing two schedules of antenatal visits: the antenatal care project. BMJ. 1996 Mar 2;312(7030):546–553. doi: 10.1136/bmj.312.7030.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Thomas P., Golding J., Peters T. J. Delayed antenatal care: does it effect pregnancy outcome? Soc Sci Med. 1991;32(6):715–723. doi: 10.1016/0277-9536(91)90151-2. [DOI] [PubMed] [Google Scholar]
  39. Villar J., Bergsjø P. Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. Acta Obstet Gynecol Scand. 1997 Jan;76(1):1–14. doi: 10.3109/00016349709047778. [DOI] [PubMed] [Google Scholar]
  40. Wulf K. H., Steck T. The impact of timing and frequency of prenatal visits on the outcome of pregnancy in the perinatal registry of Bavaria 1987-1988. Eur J Obstet Gynecol Reprod Biol. 1994 Nov;57(2):79–84. doi: 10.1016/0028-2243(94)90047-7. [DOI] [PubMed] [Google Scholar]

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