Keywords
Low birth weight (LBW)
Preterm birth
Apgar score
Neonatal outcomes
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Abstract
Objective: To evaluate the association between prenatal care adequacy, based on the Kessner index modified by Takeda and the Adequacy of Prenatal Care Utilization Index (APNCU) by Kotelchuck, and adverse neonatal outcomes, including low birth weight (LBW; birth weight <2500 g), preterm birth (<37 weeks), and a five-minute Apgar score below 7 (Ap5<7). Methods: A cross-sectional study was conducted with 1,458 postpartum women and their newborns, whose deliveries were funded by the Brazilian Unified Health System (SUS) in three public maternity hospitals in the municipality between August 2018 and February 2019. Demographic, socioeconomic, and behavioral factors, as well as pregnancy characteristics and services utilized by pregnant women, were analyzed. Results: The mean number of prenatal visits was 8.0, with an average initiation of care at 12.9 weeks (SD = 6.5). The proportion of adequate prenatal care was 71.1% according to Kessner/Takeda and 35.0% based on APNCU. The Takeda index showed significant differences for all three outcomes analyzed, even after controlling for confounding factors, highlighting a higher prevalence of LBW in the intermediate category (23.2%) compared to 9.3% in the adequate prenatal care group and higher prevalence of preterm birth and Ap5<7 in both the intermediate (26.7% and 4.5%) and inadequate (24.1% and 4.7%) categories compared to the adequate category (13.8% and 1.7%). Inadequate prenatal care based on APNCU was associated only with preterm birth. Conclusion: Prenatal care adequacy has a significant impact on neonatal outcomes. This study underscores the importance of applying quality care indices to evaluate the performance of health programs.
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