Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study

Vidal, Eglídia Carla Figueirêdo; Oliveira, Lara Leite de; Oliveira, Camila Almeida Neves de; Balsells, Marianne Maia Dutra; Barros, Maria Aline Rodrigues; Vidal, Emery Ciana Figueirêdo; Pinheiro, Ana Karina Bezerra; Aquino, Priscila de Souza

doi:10.1590/1980-220X-REEUSP-2023-0145en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0145en copy

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study^* ASSOCIATE EDITOR Rebeca Nunes Guedes de Oliveira

Cuidados prenatales asociados a los resultados neonatales en maternidades: un estudio transversal hospitalario

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals.

Method:

Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact.

Results:

There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support.

Conclusion:

Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

DESCRIPTORS
Prenatal Care; Maternal and Child Health; Nursing; Obstetrics; Maternal Health Services

Variables for PN care	Macro region					p-value*
Variables for PN care	Cariri n (%)	Fortaleza n (%)	Sertão central n (%)	Sobral n (%)	Ceará n (%)	p-value*
Start of PN
Up to 12 weeks	40 (80%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	90 (50.3%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	46 (59.7%)	80 (59.7%)	256 (58.2%)	0.002
Over 12 weeks	10 (20%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	89 (49.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	31 (40.3%)	54 (40.3%)	184 (41.8%)
Number of PN visits
Up to 6	10 (20.4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	77 (52.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	24 (31.2%)	35 (27.5%)	146 (34.1%)	0.002
7 or more	39 (79.6%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	98 (34.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	53 (68.8%)	92 (72.4%)	282 (65.9%)
Vaccines during pregnancy
Yes	50 (100%)	168 (96%)	68 (90.7%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	130 (99.2%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	416 (96.5%)	0.006
No	0 (0%)	7 (4%)	7 (9.3%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	1 (0.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	15 (3.5%)
HIV tests during pregnancy
Yes	48(96%)	157(90.2%)	65(87.8%)	119(90.8%)	389(90.7%)	0.489
No	2(4%)	17(9.8%)	9(12.2%)	12(9.2%)	40(9.3%)
Tests for syphilis in pregnancy
Yes	47(94%)	154(86.5%)	70(90.9%)	104(78.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	375(85.8%)	0.020
No	3(6%)	24(13.5%)	7(9.1%)	28(21.2%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	62(14.2%)
Professional who carried out the PN
Both	41(83.7%)	128(74.4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	62(83.8%)	113(86.3%)	344(80.7%)	0.004
Nurse	3(6.1%)	15(8.7%)	6(8.1%)	15(11.5%)	39(9.1%)
Physician	5(10.2%)	29(16.9%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	6(8.1%)	3(2.3%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	43(10.2%)
Complications during pregnancy
Yes	9 (18%)	36 (49.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	18 (24.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	4 (3.1%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	67 (15.5%)	<0.001
No	41 (82%)	142 (79.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	55 (75.3%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	127 (96.9%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	365 (84.5%)
Risk stratification at admission
High risk	6 (12%)	27 (15.1%)	15 (19.5%)	17 (12.7%)	65(14.7%)	0.544
Normal risk	44 (88%)	152 (84.9%)	62 (80.5%)	117 (87.3%)	375(85.3%)
Delivery at municipality of residence
Yes	21(42%)	133(74.3%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	33(43.4%)	44(32.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	231(52.6%)	<0.001
No	29(58%)	46(25.7%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	43(56.6%)	90(67.2%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	208(47.4%)
Prematurity (<37 weeks)
Yes	9(18%)	35(21.1%)	7(9.9%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	27(21.3%)	78(18.8%)	0.187
No	41(82%)	131(78.9%)	64(90.1%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	100(78.7%)	336(81.2%)
Low birth weight (<2500g)
Yes	4(8%)	24(14.5%)	9(11.7%)	25(18.8%)	62(14.1%)	0.222
No	46(92%)	155(85.5%)	68(88.3%)	108(81.2%)	377(85.9%)
1st minute Apgar
Up to 7	5(11.4%)	28(15.7%)	3(4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	23(17.6%)	59(13.8%)	0.039
Over 7	39(88.6%)	150(84.3%)	72(96%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	108(82.4%)	369(86.2%)
5th minute Apgar
Up to 7	3(6.8%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	2(1.1%)	1(1.4%)	3(2.3%)	9(2.1%)	0.122
Over 7	41(93.2%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	176(98.9%)	73(98.6%)	129(97.7%)	419(97.9%)
Ventilatory support for NB after birth
Yes	5(10%)	16(8.9%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	7(9.1%)	29(21.6%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	57(12.9%)	0.005
No	45(90%)	163(91.1%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	70(90.9%)	105(78.4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	383(87.1%)
Immediate neonatal resuscitation
Yes	1(2%)	3(1.7%)	0(0%)	4(3%)	8(1.8%)	0.479
No	49(98%)	176(98.3%)	77(100%)	130(97%)	432(98.2%)

	Prematurity			Low weight			1st minute Apgar ≤ 7			5th minute Apgar ≤ 7			Ventilatory support			Neonatal resuscitation
	Yes	%	p-value	Yes	%	p-value	Yes	%	p-value	Yes	%	p-value	Yes	%	p-value	Yes	%	p-valor
Start of PN
More than 12 weeks	31	17.9	0.685^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	24	13.1	0.608^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	26	14.5	0.706^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	1.7	0.740^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	25	13.6	0.738^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	1.6	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Up to 12 weeks	47	19.5		38	14.8		33	13.3		6	2.4		32	12.5		5	2
PR/CI 95%	0.91 [0.610-1.384]			0.884 [0.550-1.420]			1.096 [0.680-1.765]			0.69 [0.176-2.744]			0.92 [0.565-1.498]			0.83 [0.202-3.449]
Pregnancy complications
Yes	12	19.4	0.759^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	8	11.9	0.610^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	11	16.9	0.423^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	1.6	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	5	7.5	0.159^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	0	0	0.616^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
No	61	17.7		52	14.3		47	13.2		8	2.2		50	13.7		8	2.2
PR /CI 95%	1.091 [0.625-1.905]			0.83 [0.416-1.679]			1.282 [0.703-2.338]			0.697 [0.089-5.480]			1.83 [0.760-4.433]			1.022 [1.007-1.038]
Number of PN visits
Up to 6	39	28.3	<0.001*	33	22.6	<0.001*	18	12.8	0.701^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	1.4	0.722^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	22	15.1	0.184^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	1.4	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
7 or more	37	13.8		27	9.6		39	14.1		6	2.2		30	10.6		5	1.8
PR /CI 95%	2.04 [1.372-3.054]			2.35 [1.474-3.755]			0.903 [0.537-1.520]			0.650 [0.133-3.180]			1.41 [0.848-2.365]			0.77 [0.152-3.934]
Vaccines during pregnancy
No	4	33.3	0.244^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	20	0.444^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	7.1	0.703^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	7.1	0.265^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	6.7	0.705^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	0	0	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Yes	70	17.8		56	13.5		57	14		8	2		54	13		8	1.9
PR /CI 95%	1.87 [0.818-4.283]			1.48 [0.523-4.198]			0.509 [0.076-3.415]			3.62 [0.486-27.039]			1.94 [0.288-13.146]			1.02 [1.006-1.033]
HIV tests during pregnancy
No	8	21.6	0.531^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	8	20	0.252^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	7.5	0.220^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	2.5	0.599^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	5	0.120^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	2.5	0.546^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Yes	64	17.5		52	13.4		55	14.6		8	2.1		53	13.6		7	1.8
PR /CI 95%	1.23 [0.644-2.375]			1.49 [0.764-2.915]			0.515 [0.169-1.573]			1.18 [0.152-9.205]			0.36 [0.093-1.450]			1.38 [0.175-11.008]
Tests for syphilis in pregnancy
No	13	22.4	0.438^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	8	12.9	0.790^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	7	11.3	0.559^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	4.8	0.130^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	4.8	0.043^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	3.2	0.317^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Yes	64	18.1		53	14.2		51	14		6	1.7		53	14.1		6	1.6
PR /CI 95%	1.23 [0.729-2.095]			0.911 [0.455-1.821]			0.804 [0.382-1.689]			2.92 [0.752-11.400]			0.34 [0.110-1.062]			2.01 [0.416-9.765]
Professional who carried out the PN
Both	58	18.1	0.870^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	46	13.4	0.677^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	46	13.7	0.577^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	6	1.8	0.355^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	45	13.1	0.781^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	7	2	0.657^# * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Nurse	8	21.6		7	17.9		4	10.8		2	5.4		5	12.8		0	0
Physician	8	18.6		7	16.3		8	18.6		1	2.3		4	9.3		1	2.3
Risk stratification at admission
High risk	15	25	0.187^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	17	26.6	0.002*	13	20.6	0.088^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	3.2	0.627^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	14	21.5	0.026*	0	0	0.611^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Normal risk	63	17.8		45	12		46	12.6		7	1.9		43	11.5		8	2.1
PR /CI 95%	1.40 [0.859-2.298]			2.21 [1.355-3.617]			1.63 [0.940-2.851]			1.65 [0.352-7.788]			1.878 [1.092-3.232]			1.02 [1.007-1.037]
Delivery at maternity of residence
No	42	21.5	0.185^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	38	18.4	0.017*	32	15.9	0.235^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	6	3	0.318^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	34	16.3	0.047*	4	1.9
Yes	36	16.4		24	10.4		27	11.9		3	1.3		23	10		4	1.7	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
PR /CI 95%	1.31 [0.877-1.957]			1.76 [1.098-2.842]			1.33 [0.828-2.144]			2.22 [0.564 – 8.782]			1.642 [1.001-2.693]			1.111 [0.281-4.384]

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E-mail: reeusp@usp.br

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[1] Corresponding author: Camila Almeida Neves de Oliveira Av. Dário Rabêlo, 977, Sete de Setembro 63500-000 – Iguatu, CE, Brazil camilaandeoliveira@gmail.com

Brasil

Brasil

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study* ASSOCIATE EDITOR Rebeca Nunes Guedes de Oliveira

Cuidados prenatales asociados a los resultados neonatales en maternidades: un estudio transversal hospitalario

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study^* ASSOCIATE EDITOR Rebeca Nunes Guedes de Oliveira