J Korean Soc Matern Child Health.  2018 May;22(2):112-123. 10.21896/jksmch.2018.22.2.112.

The Association between Adequate Prenatal Care and Severe Maternal Morbidity: A Population-based Cohort Study

• Nam JY
• Park EC

• KMID: 2412466
• DOI: http://doi.org/10.21896/jksmch.2018.22.2.112

Abstract

PURPOSE
This study identified the relationship between adequate prenatal care and severe maternal morbidity among delivered women.
METHODS
Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 91,767 cases of delivery that were delivered during 2003~2013. Severe maternal morbidity status was determined using the Center for Disease Control and Prevention's algorithm including the diagnosis and procedure code during delivery and postpartum hospitalization. A generalized estimating equation (GEE) model with log link was performed for the relationship with severe maternal morbidity and women's factors to estimate adjusted relative risk.
RESULTS
Of the 91,767 delivery cases, 2,248 (2.45%) had severe maternal morbidity. In the GEE model, severe maternal morbidity was higher in women who had inadequate prenatal care than in those who had adequate prenatal care (relative risk (RR) 1.39, 95% CI 1.11~1.75, p-value 0.0045). For maternal age, women who delivered at extremely young or old ages had high risks of severe maternal morbidity, which showed a U-shaped distribution through the whole age range. Women who had the lowest level of income, who had cesarean section delivery, who were nulliparous, who had twins or more than triplet births had high risks of severe maternal morbidity.
CONCLUSION
Inadequate prenatal care delivery was associated with the occurrence of severe maternal morbidity. Therefore, policy makers should consider making quality indicators for early, timely, and sufficient visits during pregnancy and should monitor adequacy of prenatal care to prevent severe maternal morbidity.

Keyword

severe maternal morbidity; CDC's SMM indicator; prenatal care; Kessner Adequacy of Prenatal Care Index

MeSH Terms

Administrative Personnel
Centers for Disease Control and Prevention (U.S.)
Cesarean Section
Cohort Studies*
Diagnosis
Female
Hospitalization
Humans
Maternal Age
National Health Programs
Parturition
Postpartum Period
Pregnancy
Prenatal Care*
Triplets
Twins