Emory University School of Medicine Department of Gynecology and Obstetrics, Glenn Building, 4th Floor - 412B, 69 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
Massachusetts General Hospital Department of Obstetrics and Gynecology, 55 Fruit St, Boston, MA, 02114, USA.
Matern Child Health J. 2021 Feb;25(2):311-320. doi: 10.1007/s10995-020-03023-0. Epub 2020 Nov 17.
Antenatal care (ANC) is designed to improve pregnancy outcomes by providing screening and treatment for preventable and treatable diseases. However, data are lacking on whether ANC affects stillbirth risk. We hypothesized stillbirth risk in Uganda is lower in women attending the recommended ≥ 4 ANC visits compared to those attending ≤ 3.
We performed a secondary analysis of subset of 1,785 women enrolled in a prospective cohort of postpartum infection who presented to a regional referral hospital for delivery. Our primary outcome was documented stillbirth; a secondary composite poor birth outcome included stillbirth, early neonatal death, low birth weight (< 2500 g), and 5-min APGAR score < 7. We performed multivariable logistic regression analyses to identify independent correlates of stillbirth and poor birth outcome.
Of 1,785 participants, 58 (3%) pregnancies resulted in stillbirth and 198 (11%) had a poor birth outcome. Of 1,236 women attending ≥ 4 ANC visits, 31 (2.5%) had a stillbirth, compared to 27/510 (5.2%) attending ≤ 3. In multivariable analyses controlling for age, parity, distance traveled, referral status to hospital, malaria prophylaxis, and syphilis infection; attending ≥ 4 ANC visits was associated with significantly reduced odds of stillbirth (aOR 0.5, 95% CI 0.3-0.9, P = 0.02) and poor birth outcome (aOR 0.66, 95% CI 0.4-0.96, P = 0.03). Malaria prophylaxis was also independently associated with reduced odds of stillbirth (aOR 0.05, 95% CI 0.2-1.0, P = 0.04).
Attending ≥ 4 ANC visits was associated with reduced odds of stillbirth and poor birth outcomes in this Ugandan cohort, which may be related to more comprehensive infection screening, treatment, and prevention services.
产前保健（ANC）旨在通过为可预防和可治疗的疾病提供筛查和治疗来改善妊娠结局。然而，关于 ANC 是否会影响死产风险的数据尚不清楚。我们假设在乌干达，接受建议的≥4 次 ANC 检查的女性的死产风险低于接受≤3 次 ANC 检查的女性。
我们对参加产后感染前瞻性队列研究的 1785 名女性中的一部分进行了二次分析，这些女性在一家地区转诊医院分娩。我们的主要结局是记录死产；次要复合不良出生结局包括死产、新生儿早期死亡、低出生体重（<2500g）和 5 分钟 APGAR 评分<7。我们进行了多变量逻辑回归分析，以确定死产和不良出生结局的独立相关因素。
在 1785 名参与者中，58 例（3%）妊娠导致死产，198 例（11%）发生不良出生结局。在 1236 名接受≥4 次 ANC 检查的女性中，有 31 例（2.5%）发生死产，而在 510 名接受≤3 次 ANC 检查的女性中，有 27 例（5.2%）发生死产。在控制年龄、产次、旅行距离、转诊状态、疟疾预防和梅毒感染的多变量分析中；接受≥4 次 ANC 检查与死产的可能性显著降低相关（优势比 0.5，95%置信区间 0.3-0.9，P=0.02）和不良出生结局（优势比 0.66，95%置信区间 0.4-0.96，P=0.03）。疟疾预防也与降低死产的可能性独立相关（优势比 0.05，95%置信区间 0.2-1.0，P=0.04）。
在乌干达队列中，接受≥4 次 ANC 检查与降低死产和不良出生结局的可能性相关，这可能与更全面的感染筛查、治疗和预防服务有关。
