153 Neonatal Outcomes of Inadequate Prenatal Care
Notice bibliographique
Résumé
Prenatal care (PNC) is a frequently accessed Canadian healthcare service, yet 5–20% of women obtain inadequate PNC. An understanding of neonatal outcomes associated with inadequate prenatal care will assist in developing appropriate guidelines for these at risk infants and identifying the importance of engaging hard-to-reach pregnant patients in healthcare. To compare neonatal outcomes of babies born to women who received no or inadequate prenatal care (IPNC) with those born to women who received adequate prenatal care (APNC). We conducted a retrospective matched cohort study with approval from our local research ethics committee. Neonates born at an inner-city hospital in 2016 to women with IPNC (≤4 antenatal visits, or first visit in 3rd trimester) were identified through retrospective chart review. APNC controls (≥5 prenatal visits and initial visit prior to third trimester), were matched 3:1 for age and parity. Seventy newborns were born to women with IPNC, and 210 maternal-matched controls were identified. The rate of preterm birth (<37wks GA) and small for gestational age (SGA) infants was higher in the IPNC group, 15/70 (23.4%) and 11/65 (16.9%) respectively, compared to 21/210 (10%) and 17/210 (8.10%) in the APNC group (p<0.01). The mean birthweight of IPNC newborns was 2972g (+/- 630g) vs 3375g (+/-554g) in controls. NICU admission was 27/70 (38%) for IPNC vs 23/210 (11%) for APNC (p<0.01). Neonatal abstinence syndrome (NAS) screening was done in 14/70 (20%) in the IPNC group and 4/210 (2%) of APNC group. Eleven (15.7%) of the newborns screened for NAS in the IPNC group vs 1(0.5%) in the APNC group required NICU admission for NAS and 3(4.3%) vs 0 required pharmacological treatment. Urine toxicology screen was done in 14 IPNC neonates -12 tested positive, with opiates (50%), cannabis (50%) and methamphetamines (33%) the commonest substances. In the IPNC group, 14 (20%) neonates were discharged via Child Protective Services care vs 2 (1%) in the APNC group (p<0.01). Inadequate prenatal care increases the risk of adverse neonatal outcomes, including prematurity, lower mean birthweight, SGA, and NICU admission. Neonates in the IPNC group were more likely to have had opioid exposure with subsequent NAS and to be discharged into the care of Child Protective Services. This study highlights the importance of identifying women at risk of IPNC and improving their engagement with healthcare teams.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».