Determinants of the number of antenatal visits in a metropolitan region

Abstract

Background: Antenatal care has a positive effect on pregnancy, both clinically and psychologically, but consensus about the optimal number of antenatal visits is lacking. This study aims to provide insight into the dynamics of the number of antenatal visits a woman receives. Independent effects of predisposing, enabling and pregnancy-related determinants are examined.

Methods: Women were recruited in nine clinical centres in the Brussels Metropolitan region. Antenatal care use was measured prospectively. A Poisson regression model was applied to measure the independent effect of individual determinants on the number of antenatal visits.

Results: Data on antenatal care trajectories in 333 women were collected. The multivariate analyses showed that women with a Maghreb or Turkish origin had 14% fewer visits compared with European (EU15) women. More highly educated women had 22% more visits compared with those with a low education. Women with a high income had 14% more antenatal visits compared with those with a low income. Fewer antenatal visits were observed in multiparae (15%), women initiating care after 14 weeks of gestation (31%), women without medical risks during the pregnancy (12%) and in women with a continuity of care index of 50% or more (12%). More visits were observed in delivering after week 37 (22% increase).

Conclusions: Predisposing and enabling factors have to be considered when antenatal care programmes are evaluated in a metropolitan area. Variations in the number of antenatal visits show that socially vulnerable women are more at risk of having fewer visits.

Figure 1

outline of the behaviour model by Andersen and Newman [17], reflecting individual determinants included in the analyses.

Figure 2

recruitment scheme.