Is prenatal care implemented appropriately? Effects of timing and frequency of prenatal visits on high-risk pregnancies and pregnancy outcomes

Objective: The Taiwan National Health Insurance Program covers 10 prenatal visits during maternal pregnancy. This study aimed to examine the effects of timing and frequency of prenatal visits on high-risk pregnancies and pregnancy outcomes, using a nationwide population-based dataset. Possibilities of amending prenatal care visits for ultimate healthcare utilization would be concerned. Study design: This study used data from the Taiwan National Health Insurance Research Database. A total of 213,206 mothers who had singleton births in Taiwan in 2005 were retrieved and followed till fetal birth. Multivariate logistic regression models were performed for analyses. Results: We found that as recommended, the prenatal care coverage rate was approximately 7.9, with the timing of the first visit at the 10th gestational week in Taiwan. Compared with those who utilized all first five important prenatal visits (with lab data and ultrasound examination), those who used 3-4 times experienced increased risks of having a newborn with very low birthweight (OR=3.7, 95%CI=(3.1-4.3)) and low birthweight (OR=1.2, 95%CI=(1.1-1.2)). Women who used less than 2 times experienced even higher risks of having a newborn with very low birthweight (OR=9.3, 95%CI=(7.2-11.9)), low birthweight (OR=2.0, 95%CI=(7.8-2.2)), and preterm birth (OR=1.7, 95%CI=(1.5-1.9)). Effects of the timing of the first prenatal care on high-risk pregnancies and pregnancy outcomes were further investigated. Conclusion: With appropriate prenatal care, medical intervention can be involved to promote maternal and fetal health and to decrease complication rates and death. Possibilities of amending prenatal care visits for ultimate healthcare utilization should be carefully concerned.