Association of Antenatal Risk Score With Maternal and Neonatal Mortality and Morbidity

Abstract

Introduction/Objectives Women with high-risk pregnancies require careful follow-up, management, and efficient allocation of resources to achieve optimal pregnancy outcomes. This study investigated the association between an updated, validated antenatal risk index score and neonatal mortality and morbidity in a tertiary care center in Saudi Arabia. Methods This retrospective cohort study included pregnant women delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between June 2016 and December 2018. Pregnant women who delivered before arrival, delivered in another hospital, or without an antenatal risk score because of missing data were excluded. The study cohort was recruited by simple random selection. Data of mothers and neonates were extracted from electronic health records. The pregnancy risk was assigned using a validated antenatal risk score index, creating low, moderate, and high-risk pregnancy categories. The association between antenatal risk scores, maternal and neonatal outcomes was investigated. Results A total of 533 pregnant women were included in the analysis, of whom 298 (55.9%) had low antenatal risk scores, 185 (34.7%) had moderate-risk scores, and 50 (9.4%) had high-risk scores. Maternal characteristics showed that high-risk mothers had higher age, gravidity, parity, and abortions than those with low or moderate-risk pregnancies. Newborns of high-risk mothers belonged more often to the male gender and had lower gestational ages, birth weights, and Apgar scores. For maternal outcomes, there was no maternal mortality. High-risk mothers had more cesarean sections and longer lengths of stay as compared to the low and moderate risk group. There was a trend toward increased stillbirths. Neonatal mortality, neonatal intensive care unit (NICU) admission, congenital anomalies, and length of stay were significantly increased in neonates of high-risk mothers. Conclusions An antenatal risk score is a feasible tool in identifying low, moderate, and high-risk pregnancies in a tertiary center outside a North American system. The higher scores were associated with maternal complications as well as neonatal mortality and morbidity. This is the first study to report maternal demographics, mortality, stillbirths, male gender, and congenital anomalies and their associations with categories of pregnancy level of risk. The clinical and economic benefits of antenatal risk screening in Saudi Arabia warrant further large population-based study that includes multi-domain socioeconomic determinants of health specific to our region.

Pregnancy outcome among high-risk pregnant women in the rural area of Belagavi

“…Maternal and neonatal complications were significantly increased in high-risk mothers, which suggested the use of a risk assessment method to prevent adverse pregnancy outcomes by early detection and treatment of HRP. [ 12 ]…”

Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union

“…Furthermore, it has been reported that unplanned out-of-hospital birth may be associated with an increases perinatal mortality, due to limited accessibility to certain urgent medical interventions or inadequate antenatal care [ 41 – 43 ]. Finally, the duration of the mother’s stay in the hospital may have been associated with birth outcomes [ 44 ], but the data were not available in the analyses, and might be included in future research agenda.…”

Screening for Neurodevelopmental Delay for Preterm Very Low Birth Weight Infants at Tertiary Care Center in Saudi Arabia

“…Also, this study is conducted in a single center, which might not reflect the actual prevalence in Saudi Arabia. We recommend a national multi-center study with multidomain factor assessment, including socioeconomic and antenatal variables [ 35 , 36 ]. The follow-up should be comprehensive, considering particular risks such preterm infants have, like increased risk of respiratory diseases and health care utilization, especially during the COVID-19 pandemic [ 37 - 39 ].…”

“…The follow-up should be comprehensive, considering particular risks such preterm infants have, like increased risk of respiratory diseases and health care utilization, especially during the COVID-19 pandemic [ 37 - 39 ]. National guidelines should be developed based on country-specific resources and parents' values [ 36 ].…”