Adherence to recommended prenatal visit schedules and risk for stillbirth, according to probable cause of death

Abstract

Objective: Suboptimal prenatal care is linked to increased risk of stillbirth, but this association is not well-understood. The study objective was to evaluate the relationship between prenatal visit adherence and cause of death in stillbirths.

Study design: This is a secondary analysis from the Stillbirth Collaborative Research Network of data with complete cause of death evaluation. Appropriateness of prenatal visit frequency was determined per American College of Obstetricians and Gynecologists/American Academy of Pediatrics (ACOG/AAP) recommendations and the novel Michigan Plan for Appropriately Tailored Healthcare in Pregnancy (MiPATH) guidelines. Multivariate regression controlled for differences between groups.

Results: Among 451 stillbirths included, 63.6% and 55.9% were non-adherent to ACOG/AAP and MiPATH recommendations, respectively. Non-adherent parturients according to the Michigan plan were more likely to have a stillbirth due to hypertensive disorders of pregnancy.

Conclusion: Non-adherence to prenatal visit guidelines is associated with higher risk of stillbirth due to hypertensive disorders of pregnancy.

Keywords: Antenatal surveillance; Evidence-based care; High-risk pregnancy; Hypertensive disorders of pregnancy; Preventable stillbirth.