Association between Adherence with Recommended Antenatal Care in Low-Risk, Uncomplicated Pregnancy, and Maternal and Neonatal Adverse Outcomes: Evidence from Italy

Abstract

Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure→outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2–7.9; and 2.7, 1.1–7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1–1.2; 1.9, 1.3–2.7; and 2.1, 1.5–2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5–2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.

Change in healthcare during Covid-19 pandemic was assessed through observational designs

“…For this reason, we only investigated guidelines recommended healthcare. For example, reaching the continuity with territorial interventions of patients with schizophrenic disorders [ 20 , 21 ], performing at least one echocardiographic control every year of patients with heart failure [22] , timely starting therapy with inhaled bronchodilators after discharge for COPD [23] , surgery timeliness after diagnosis of breast cancer [ 24 , 25 ], and pre-partum gynaecologic visit in the same structure where the woman will give birth [ 26 , 27 ], should be considered as "core" interventions of community care, so that failure of adherence with each of them must be regarded with concerns. Second, approaches investigating trends in the aggregated volume of specific types of healthcare must be considered reductive, as it only informs on the entirety of procedures that are delivered, not on individual patients who received them.…”