Assessing the Effect on Outcomes of Public or Private Provision of Prenatal Care in Portugal
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Assessing the Effect on Outcomes of Public or Private Provision of Prenatal Care in Portugal Sofia Correia • Teresa Rodrigues • Henrique Barros
Ó Springer Science+Business Media New York 2015
Abstract To evaluate whether public and private prenatal care users experience similar outcomes, taking into consideration maternal pre-pregnancy social and clinical risk. We studied 7,325 women who delivered single newborns at five public maternity units in Porto, Portugal. Health behaviors and prenatal care were self-reported; pregnancy complications and delivery data were retrieved from medical files. The odds of inadequate weight gain, continuing to smoke, gestational hypertension, gestational diabetes, caesarean section, preterm birth, low birthweight, and small- and large-for-gestational-age were estimated for public and private providers using logistic regression, stratified by pre-pregnancy risk profile, adjusted for maternal characteristics. 38 % of women used private prenatal care. Among low-risk women, public care users were more likely to gain excessive weight (OR 1.26; 95 % CI 1.06–1.57) and be diagnosed with gestational diabetes (OR 1.37; 95 % CI 1.01–1.86). They were less likely to have a caesarean (OR 0.63; 95 % CI 0.51–0.78) and more likely to deliver small-for-gestational-age babies (OR 1.48; Electronic supplementary material The online version of this article (doi:10.1007/s10995-015-1667-4) contains supplementary material, which is available to authorized users. S. Correia (&) T. Rodrigues H. Barros EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas, 135-139, 4050-091 Porto, Portugal e-mail: [email protected] S. Correia T. Rodrigues H. Barros Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal T. Rodrigues Department of Gynaecology and Obstetrics, Hospital Sao Joao-EPE, Porto, Portugal
95 % CI 1.19–1.83). Outcomes were similar in high-risk women although preterm and pre-labor caesarean were less frequent in public care users (OR 0.64 95 % CI 0.45–0.91; OR 0.69 95 % CI 0.49–0.97). The amount of care was not significantly related to risk profile in either case. Public care users experienced similar outcomes to those using private care, despite higher pre-pregnancy disadvantage. Low-risk women need further attention if narrowing inequalities in birth outcomes remains a priority. Keywords Prenatal care Healthcare provider Pregnancy complications Birth outcomes
Introduction Strategies to expand quantity, quality and access to prenatal care services were designed during the past halfcentury to reduce inequalities in birth outcomes [1]. Despite an increase in coverage and the improvement in mortality indicators, low birthweight and preterm births have been rising in several countries, including Portugal [2–4]. Prenatal care should generally be tailored by pregnancy risk, and more care does not guarantee a favorable outcome. For low-risk women, a small number of visits is enough to ensure appropriate
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