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Author Notes:

Rachel P. McDiehl, Glenn Building, 4th Floor - 412B, 69 Jesse Hill Jr Drive SE, Atlanta, GA 30303, Telephone: (410) 952-4220, Fax: 404-521-3589, Email: rachel.mcdiehl@emory.edu

We are grateful to all study participants, study staff, and the staff of Mbarara Regional Referral Hospital and Maternity Ward and Mbarara University of Science and Technology for their partnership in this research

The authors have no relevant financial, personal, political, intellectual or religious interests to disclose.

Subject:

Research Funding:

The research project was funded by a peer-reviewed NIH Research Training Grants # K23 AI138856-02 # R25 TW009337 (FIC/NIMH) and NIH T32 #T32AI007433 and the Harvard Global Health Institute. This secondary analysis was supported by the American Medical Women’s Association Anne C. Carter Global Health Fellowship, Infectious Diseases Society of America Medical Student Scholars Program, KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst ∣ The Harvard Clinical and Translational Science Center (TR002542), the Charles H. Hood Foundation, National Institute of Allergy and Infectious Diseases (K23AI138856) and the American Society of Tropical Medicine and Hygiene Burroughs Wellcome Fellowship. Funders played no role in conducting the research or writing the manuscript, and its contents are solely the responsibility of the authors and do not necessarily represent the official views of ASTMH or the NIH.

Keywords:

  • stillbirth
  • Uganda
  • antenatal care
  • resource-limited setting
  • neonatal death

Antenatal care visit attendance frequency and birth outcomes in rural Uganda: a prospective cohort study

Tools:

Journal Title:

MATERNAL AND CHILD HEALTH JOURNAL

Volume:

Volume 25, Number 2

Publisher:

, Pages 311-320

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objectives 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. Methods 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 (<2500g), and 5-minute APGAR score <7. We performed multivariable logistic regression analyses to identify independent correlates of stillbirth and poor birth outcome. Results 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). Conclusions 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.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/rdf).
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