Impact of Prenatal Visit Utilization on Pregnancy Outcomes within Differing Risk Populations

Abstract

Objectives: To investigate the association between number and timing of prenatal visits (PNV) and pregnancy outcomes within differing maternal risk populations [non-high-risk (“non-HR”) and high-risk (“HR”)]. Methods: Retrospective study of mothers who delivered at Banner University Medical Center Phoenix during the 2017 calendar year. Inclusion criteria included maternal documentation at time of delivery of either: complete absence of PNV or complete PNV records. Maternal groups were either classified as “non-HR” or “HR” if received any of the following diagnoses: advanced maternal age (AMA), obesity, diabetic (DM) disorders, hypertensive (HTN) disorders, or asthma. Data collection included total PNV quantity per pregnancy and trimester. Pregnancy outcomes included labor interventions, labor complications, delivery complications, and adverse neonatal outcomes. Result: Of 503 mothers in the cohort, 324 met inclusion criteria and were evenly split between non-HR (159, 49.07%) and HR mothers (165, 50.93%). Pregnancy outcomes were then compared within same risk group depending on total pregnancy PNV utilization category [low (≤8 PNV), mid (9-11 PNV), and (≥12 PNV] and frequency of PNV per trimester (“T1,” “T2,” or “T3”). Non-HR mothers with a higher total PNV category were more likely to have labor interventions (odds ratio [OR] 4.02; 95% confidence interval [CI] 1.26-12.9, p = 0.019). Non-HR mothers with higher quantities of PNV in T3 were less likely to have labor interventions (OR 0.69; 95% CI 0.48-0.98, p = 0.039). HR mothers with higher PNV quantities in T1 and T2 were less likely to have labor interventions (T1: OR 0.34; 95% CI 0.13-0.91, p = 0.032) (T2: OR 0.42; 95% CI 0.21- 0.84, p = 0.015). HR mothers with higher quantities of PNV in T2 were less likely to have labor complications (OR 0.70; 95% CI 0.51-0.98, p = 0.043). Conclusions for Practice: Labor interventions were less likely found by non-HR mothers with higher quantities of PNV in T3 and by HR mothers with higher quantities of PNV in T1 and T2. Labor interventions were more likely found by non-HR mothers with a higher total PNV category. Labor complications were less likely found by HR mothers with higher quantities of PNV in T2. Limitations include small sample size and study would therefore benefit from further investigation. Anticipated clinical benefits could include contributing to the development of tailored PNV recommendations dependent on maternal health history ultimately resulting in increased cost savings, decreased unnecessary interventions, and decreased poor outcomes.