The evolution of prenatal care delivery guidelines in the United States

Peahl, Alex; Howell, Joel D.

doi:10.1016/j.ajog.2020.12.016

Cited by 45 publications

(43 citation statements)

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“…During this time period, initiation of prenatal care was thought to impact preterm birth rates, rates of low-birth-weight infants, and infant mortality rates. [1][2][3][4] In more recent years, others have ascribed benefit to prenatal care related to reductions in maternal morbidity and mortality from preeclampsia. [5][6] However, the idea that prenatal care improves outcomes has been challenged by some, given lack of large, randomized trials and conclusive evidence.…”

Section: Resultsmentioning

confidence: 99%

“…Since the turn of the twentieth century, prenatal care services have been implemented in hopes of improving maternal mortality as well as preterm birth rates, low-birth-weight infants, and infant mortality. [1][2][3][4][5][6] In 1991, an Expert Panel on Prenatal Care convened to define the aims of prenatal care; this panel recognized several points: 1) the main purpose of prenatal care is to promote the health of the mother and baby, 2) for this intervention to be effective, it must be easily accessible to all, and 3) prenatal care serves to provide early and continued risk assessment, promote health, and provide a means for medical and psychosocial interventions and follow-up as needed. 7 Although intuitive, and encouraged for more than a century, there continues to be limited data to support the premise that access to prenatal care actually improves outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Geographic barriers to prenatal care access and their consequences

Holcomb¹,

Pengetnze²,

Steele³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Geographic barriers to prenatal care access and their consequences

Holcomb¹,

Pengetnze²,

Steele³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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“…6 Despite the policy commitment to improving the accessibility and quality of prenatal care, rigorous evidence regarding the effect of prenatal care services on maternal and newborn outcomes is inadequate. [6][7][8] High-quality prenatal care is a widely recognized determinant of pregnancy outcomes. Clinical guidelines recommend at least 12 prenatal visits and 2 ultrasound scans, but many patients receive considerably more intensive monitoring and testing.…”

Section: Introductionmentioning

confidence: 99%

“…7,14 Much of the content of prenatal care guidelines has persisted for decades without strong causal evidence to demonstrate its value. 7,8 Strong evidence on the link between prenatal care intensity and pregnancy outcomes is difficult to generate because patients who receive more intensive prenatal care are different from those who do not in many ways that can confound this relationship. 15 For example, patients with more prenatal monitoring are more likely to have underlying risk factors and to be of higher socioeconomic status, both of which influence the risk of poor pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Association of Prenatal Care Services, Maternal Morbidity, and Perinatal Mortality With the Advanced Maternal Age Cutoff of 35 Years

2021

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IMPORTANCE Maternal and perinatal mortality remain high in the US despite growing rates of prenatal services and spending, and little rigorous evidence exists regarding the impact of prenatal care intensity on pregnancy outcomes. Patients with an expected date of delivery just after their 35th birthday may receive more intensive care owing to the advanced maternal age (AMA) designation; whether this increase in prenatal care is associated with improvements in outcomes has not been explored. OBJECTIVETo determine the association between the AMA designation and prenatal care services, severe maternal morbidity, and perinatal mortality. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used a regression discontinuity design to compare individuals just above vs just below the 35-year AMA cutoff, using unidentifiable administrative claims data from a large, nationwide commercial insurer. All individuals with a delivery between January 1, 2008, and December 31, 2019, who were aged 35 years within 120 days of their expected date of delivery were included in the study. Analyses were performed from July 1, 2020, to February 1, 2021. EXPOSURES Individuals who were aged 35.0 through 35.3 years on the expected date of delivery were designated as AMA. MAIN OUTCOMES AND MEASURES Outcomes were visits with specialists (obstetriciangynecologists and maternal-fetal medicine), ultrasound scan use, antepartum fetal surveillance, aneuploidy screening, severe maternal morbidity, preterm birth or low birth weight, and perinatal mortality. RESULTSThe analysis included 51 290 individuals (mean [SD] age; 34.5 [0.5] years); 26 108 individuals (50.9%) were aged 34.7 to 34.9 years and 25 182 individuals (49.1%) were aged 35.0 to 35.3 years on the expected date of delivery. A total of 2407 pregnant individuals (4.7%) had multiple gestation, 2438 (4.8%) had pregestational diabetes, 2265 (4.4%) had chronic hypertension, and 4963 (9.7%) had obesity. Advanced maternal age was associated with a 4.27 percentage point increase in maternal-fetal medicine visits (95% CI, 2.27-6.26 percentage points; P < .001), a 0.21 unit increase in total ultrasound scans (95% CI, 0.06-0.37; P = .006), a 15.67 percentage point increase in detailed ultrasound scans (95% CI, 13.68-17.66 percentage points; P < .001), and a 4.86 percentage point increase in antepartum surveillance (95% CI, 2.83-6.89 percentage points; P < .001). The AMA designation was associated with a 0.39 percentage point decline in perinatal mortality (95% CI, −0.77 to −0.01 percentage points; P = .04). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, the AMA designation at age 35 years was associated with an increase in receipt of prenatal monitoring and a small decrease in perinatal (continued) Key Points Question What is the association between the advanced maternal age (AMA) cutoff of 35 years and prenatal care service intensity, severe maternal morbidity, and perinatal mortality? Findings In this cross-sectional study of 51 290 deliveries, using regression discontinuity methods,...

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“…During the pandemic, these approaches were incorporated into antenatal care, and clinical providers of obstetrics were forced to modify antenatal care schedules and antenatal testing protocols to provide sufficient care whilst maximising social distancing. Indeed, according to authors of a review article about prenatal care, the COVID‐19 pandemic resulted in the greatest changes to antenatal care in modern history 8 . Subsequent epidemiologic studies have shown that preterm birth rates declined in some countries 9 during the pandemic and stillbirth rates increased in some settings 10 .…”

mentioning

confidence: 99%