The use of adequate prenatal care may be beneficial to women’s postpartum health. According to an analysis of data from a nationally representative sample of 8,222 Taiwanese women who gave birth in 2005, approximately 70% had received adequate prenatal care.1 Among women who had delivered vaginally, adequate prenatal care was associated with a 44% reduction in the risk of rehospitalization within six months postpartum; no association was found among women who had delivered by cesarean section.
To examine the relationship between the receipt of adequate prenatal care and maternal health, researchers analyzed claims data for inpatient and outpatient visits from Taiwan’s Longitudinal Health Insurance Database, which collects data from the country’s national health insurance program. The researchers chose to use data from Taiwan because its national health insurance program covers virtually the country’s entire population and provides pregnant women with a package of maternal care services that includes free prenatal care, free delivery services and postnatal care with only a small copayment.
Analyses focused on two nationally representative samples of women who gave birth in 2005: those who delivered vaginally and those who delivered by cesarean section. An identifier unique to each beneficiary was used to link individual women to their service utilization records for prenatal care within 40 weeks of delivery, as well as for all health services in 2004 and in the six months after delivery. The researchers constructed a measure of adequate prenatal care utilization on the basis of five conditions (e.g., had not received any prenatal care by the 16th week of pregnancy, had four or fewer prenatal care visits by the 34th week of pregnancy); women who met none of the conditions were considered to have had adequate prenatal care. Recursive bivariate probit models were used to estimate the association between adequate prenatal care and women’s risk of hospitalization within the six months after delivery.
Analyses were based on 5,403 women who had delivered vaginally and 2,819 women who had had a cesarean section. In general, the characteristics of the two groups were similar. However, 22% of the vaginal delivery group were aged 24 or younger, 38% were 25–29, 30% were 30–34 and 10% were 35 or older; the proportions for the cesarean group were 13%, 33%, 34% and 19%, respectively. Also, the mean amount spent on medical expenditures in 2004 was NT$77,982 (US$2,599) among women who had delivered vaginally and NT$74,952 (US$2,498) among women who had had a cesarean section. Some 45% of the vaginal delivery group lived in the North region of Taiwan, 27% in the Center, 26% in the South and 2% in the East; the proportions for the cesarean group were 47%, 22%, 28% and 2%, respectively.
The proportion of women who had received adequate prenatal care was 68% in the vaginal delivery group and 70% in the cesarean group. The rehospitalization rate was 0.6% among women who had delivered vaginally and 0.7% among women who had had a cesarean section. In addition, the mean postpartum medical expenditure was NT$19,122 (US$637) for the vaginal delivery group and NT$32,310 (US$1,077) for the cesarean group. Among women who had delivered vaginally, the rehospitalization rate was 0.5% for those who had had adequate prenatal care and 0.8% for those who had not; mean postpartum medical expenditures of women who had received adequate prenatal care were less than half those of women who had not. However, the rehospitalization rates were reversed among women who had had a cesarean section (0.8% among women with adequate prenatal care and 0.5% among those without), and mean medical expenditures did not differ by prenatal care.
Results from the recursive bivariate probit models showed that receipt of adequate prenatal care varied by geographic location, facility type and physician’s gender in both the vaginal delivery and cesarean groups. In addition, among women who had delivered vaginally, having received adequate prenatal care was associated with a 44% reduction in the risk of rehospitalization within six months of delivery; no association was found between prenatal care and rehospitalization among the cesarean group.
The authors acknowledge some limitations of their study, such as their narrow measure of maternal health; their ability to measure only prenatal care quantity, not quality; and the lack of data on women’s previous pregnancies and other characteristics known to be associated with prenatal care use. Even so, they comment that "it is clear that adequate prenatal care is in fact beneficial for the well-being of the vaginal delivery group of mothers." The authors conclude that "governments around the world need to more actively promote the use of prenatal care and reach out to women who might have difficulties in seeking prenatal care so as to improve the health of both newborns and mothers."
—J. Rosenberg
REFERENCE
1. Liu TC et al., Does prenatal care benefit maternal health? A study of postpartum maternal care use, Health Policy, 2015, 119(10):1382–1389.