Association between antenatal care visit and preterm birth: a cohort study in rural Bangladesh

Abstract

BackgroundStrengthening the antenatal care programme is suggested as one of the public health strategies to reduce preterm birth burden at a population level. However, the evidence so far available is inconclusive.ObjectivesTo evaluate the association between antenatal care (ANC) visit and preterm birth; and also to explore to what extent the increased usage of ANC after the initiation of the Maternal, Neonatal and Child Health (MNCH) project in Matlab, Bangladesh, contributed to the reduction of preterm birth.SettingThis population-based cohort study was conducted in Matlab, a subdistrict under Chandpur. The analysis was based on data collected from 2005 to 2009. In 2007, an MNCH project was initiated in the area that strengthened the ongoing ANC services.ParticipantsIn total, 12 980 live births with their mothers during the study period were included in the analysis.AnalysisWe performed logistic regression with generalised estimating equation models to evaluate the associations.Outcome measuresPreterm birth.ResultsThe number of ANC visits was associated with preterm birth in a dose-dependent way (p for linear trend <0.001). The adjusted odds of preterm birth were 2.4-times higher (OR 2.37, 95% CI 2.07 to 2.70) among women who received ≤1 ANC compared with women who received ≥3 ANC. We observed a significant reduction of preterm birth rates (OR 0.69, 95% CI 0.61 to 0.77) in the period after (2008 to 2009) MNCH project initiation in comparison to the period before (2005 to 2006). Controlling for ANC visits substantially attenuated this observed effect of the MNCH project on preterm birth (OR 0.88, 95% CI 0.77 to 0.99) (Sobel test of mediation p<0.001).ConclusionsANC visits are associated with decreased occurrences of preterm births. Strengthening the ANC services should be prioritised in countries with high preterm birth rates to reduce the preterm birth burden at the population level.

Association between intimate partner violence during pregnancy and risk of preterm birth

“…An association between antenatal care service utilization and preterm birth has been found in prior studies [29][30][31][32]. Other previous studies suggest that antenatal care service utilization may be useful only in identifying high-risk women but can also facilitate timely intervention [29,33].…”

“…An association between antenatal care service utilization and preterm birth has been found in prior studies [29][30][31][32]. Other previous studies suggest that antenatal care service utilization may be useful only in identifying high-risk women but can also facilitate timely intervention [29,33]. The risk of preterm birth has also been shown to be higher among pregnant women who start antenatal care late than those who start early [34,35].…”

Do women’s empowerment and socioeconomic status predict the adequacy of antenatal care? A cross-sectional study in five South Asian countries

“…2 4 5 Evidence suggests that women’s use of adequate ANC had a strong association with a lower occurrence of preterm births, and ANC alone can reduce maternal mortality by 20%, given the good quality and regular attendance. 6 7 …”

Towards stronger antenatal care: Understanding predictors of late presentation to antenatal services and implications for obstetric risk management in Rwanda

“…Leading causes of maternal mortality in sub-Saharan Africa, including hypertensive disorders and pregnancy-related infections, can be mitigated in the antenatal period resulting in lower mortality rates [ 9 , 10 ]. Decreased rates of preterm birth, a common cause of neonatal morbidity and mortality in low-resources settings, have been linked to increased attendance at ANC [ 11 ]. Surveillance throughout the antenatal period for conditions such as diabetes, anemia and HIV can further reduce obstetric complications through early monitoring and management [ 12 , 13 ].…”