Assessment of the Adequacy of Prenatal Care With Different Evaluation Indices Using Maternal and Fetal Outcomes: A Cross-Sectional Study

Abstract Objective: To investigate the effectiveness and efficiency of different evaluation indices in assessing adequate prenatal care (PNC) in relation to maternal and fetal outcomes. Methods: A secondary data analysis of multiple cross-sectional surveys of 221,381 new mothers (weighted estimate 10,932,150) from Phase 8 Pregnancy Risk Assessment Monitoring System between 2016 and 2021. PNC adequacy was assessed using the Kessner, Kotelchuck, and Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) indices. Descriptive, bi-variate, and multivariate analyses were performed to evaluate the impact of each index on maternal and fetal outcomes, with the level of statistical significance set at P < 0.010 and 95% confidence interval ( CI ). Results: The prevalence of adequate PNC using the Kessner, Kotelchuck, and MiPATH indices was 74.1% (7,675,029/10,361,625), 77.1% (8,218,603/10,664,993) and 20.1% (2,131,242/10,597,981), respectively. Women with adequate PNC, according to all three indices, showed lower rates of adverse fetal and maternal outcomes. Each index was significantly associated with fetal outcomes (neonatal infant care unit admission, small for gestational age, and preterm birth) and mode of delivery ( P < 0.010). In multivariate analysis, MiPATH index consistently predicted lower odds of neonatal intensive care unit admission (odds ratio ( OR ): 0.475, 95% CI : 0.417–0.541), cesarean delivery ( OR : 0.786, 95% CI : 0.757–0.816), and preterm birth ( OR : 0.285, 95% CI : 0.263–0.309). Adequate PNC as defined by Kessner was associated with decreased the odds of neonatal intensive care unit admission ( OR : 0.890, 95% CI : 0.821–0.965), small for gestational age ( OR : 0.849, 95% CI : 0.729–0.990), and preterm birth ( OR : 0.453, 95% CI : 0.430–0.476), while Kotelchuck was associated with increased odds of preterm birth ( OR : 2.820, 95% CI : 2.661–2.989), and cesarean delivery ( OR : 1.231, 95% CI : 1.187–1.277). Conclusion: While all indices effectively assessed adequate PNC, the MiPATH index proved to be the most effective, considering its criteria for flexibility and individualized care, along with its association with improved fetal and maternal outcomes among women with adequate PNC.