Prevalence of Prenatal Care Visits Among Pregnant Women and Its Impact on Risk of Preterm Births in West Virginia

Background: Prenatal care strongly influences the risk of preterm birth which contributes to neonatal morbidity and mortality. This study assesses the prevalence of prenatal care received by pregnant women in West Virginia, and its impact on risk of preterm birth.

Methods: The study cohort included all women who gave birth between May 2018 and March 2020 in West Virginia. Number of prenatal clinic visits (PNC), gestational age of infant, demographic information including race, health insurance, maternal age and education, prior pregnancies, maternal diabetes, and substance use during pregnancy were obtained through population level data from Project WATCH (state mandate surveillance tool). Preterm birth was infants born at < 37weeks and term birth was infants born at or ≥37 weeks). The number of PNC was classified into either <10 or ≥10 visits. Multivariate analysis was performed using logistic regression.

Results: There were 36,307 women who gave birth between May 2018 and March 2020 in West Virginia. Of these, 12.42% (n=4,260) infants were born preterm while 87.58% (n=30,039) were born at term. The odds of having preterm birth in women who had PNC <10 was 2.55 when compared with women who had PNC ≥ 10 (OR: 2.55; 95% CI: 2.35 – 2.77). After adjusting for demographic factors, the association between preterm birth and prenatal care remained statistically significant (adjusted odds ratio [aOR]: = 2.54; 95% CI 2.31 – 2.80). Maternal age, race, and number of previous pregnancies were not statistically significant in the adjusted model and were removed from the model. We observed greater odds of infants being born preterm with reported substance use during pregnancy vs women with no substance use during pregnancy (aOR:1.18, 95% CI:1.05 – 1.33), women on Medicaid insurance vs women with private health insurance (aOR:1.11, 95% CI:1.03 – 1.20), women aged between 30 – 39 years vs women aged between 20 – 29 years (aOR: 1.14 95% CI: 1.05 – 1.23), women aged ≥ 40 years vs women 20 – 29 years (aOR:1.55, 95% CI: 1.24 – 1.94), women with gestational diabetes vs. no diabetes (aOR:1.63, 95% CI:1.45 – 1.83) and women with type I or type II Diabetes Mellitus (DM) vs women with no history of diabetes (aOR: 4.37, 95% CI: 3.53 – 5.40).

Conclusion: West Virginia has high rates of preterm birth compared to the national average. As PNC visits ( <10) are associated with preterm birth, public health initiatives need to be undertaken to improve maternal and infant outcomes at the population level.