Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba

Abstract

BackgroundEnsuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care.MethodsWe studied women giving birth in Manitoba from 2004/05–2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information.ResultsOverall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use.ConclusionThe rate of inadequate prenatal care in Manitoba ranged from 10.5–12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.

Prescription medication use during pregnancies that resulted in births and abortions (2001-2013): A retrospective population-based study in a Canadian population

“…All women with a pregnancy outcome identified through hospital discharge records and medical claims data [16] and continuous healthcare coverage from 365 days preconception to 90 days post-partum between the calendar years 2001 and 2013 were included. Pregnancy outcomes were identified through hospital discharge records and medical claims data included: (1) livebirth, stillbirth, or intrauterine death (ICD9CM V27, 656.4, ICD10 Z37, O36.4); and (2) spontaneous and induced abortion ICD9CM 632, 634–637, ICD10 O03-O05, ICD9-CM procedure codes 6901, 6951, 7491, 750, ICD-10 procedure code 5.CA 88–90).…”

Prenatal care among mothers involved with child protection services in Manitoba: a retrospective cohort study

“…23 At the birth of the first child, we considered the year (1998-2003, 2004-2009, 2010-2015) to account for potential changes in policies, mother's age, location (urban was defined as neighbourhoods in Winnipeg and Brandon, and rural was defined as all other Manitoba neighbourhoods) and income quintile of the neighbourhood in which the mother lived. 5,24,25 Information for 3 social variables at the birth of the first child were available for a subpopulation of women for whom the BabyFirst or Families First Screen form was completed: education (less than high school/completed high school), single mother (yes/no) and social isolation (yes/no). 24 In the interval between the birth of the mother's first child and conception of her second child, we considered the length of this time period, whether she had moved (defined as at least 1 change in postal code), received income assistance (for at least 2 consecutive months), or had been diagnosed with substance use disorder, diabetes or hypertension.…”

“…5,24,25 Information for 3 social variables at the birth of the first child were available for a subpopulation of women for whom the BabyFirst or Families First Screen form was completed: education (less than high school/completed high school), single mother (yes/no) and social isolation (yes/no). 24 In the interval between the birth of the mother's first child and conception of her second child, we considered the length of this time period, whether she had moved (defined as at least 1 change in postal code), received income assistance (for at least 2 consecutive months), or had been diagnosed with substance use disorder, diabetes or hypertension. 24,26 We defined diabetes as at least 1 physician visit or at least 1 admission to hospital with a diagnosis of diabetes (ICD-9-CM code 250; ICD-10-CA codes E10-E14), and hypertension as at least 1 physician visit or at least 1 admission to hospital with a diagnosis of hypertension (ICD-9-CM codes 401-405; ICD-10-CA codes I10-I13, I15).…”

“…24,26 We defined diabetes as at least 1 physician visit or at least 1 admission to hospital with a diagnosis of diabetes (ICD-9-CM code 250; ICD-10-CA codes E10-E14), and hypertension as at least 1 physician visit or at least 1 admission to hospital with a diagnosis of hypertension (ICD-9-CM codes 401-405; ICD-10-CA codes I10-I13, I15). 24…”

Heart Disease, Hypertension, Gestational Diabetes Mellitus, and Preeclampsia/Eclampsia in Mothers With Juvenile Arthritis: A Nested Case–Control Study

“…(ICD‐9 420–429, ICD‐10 I30–I52). Prepregnancy hypertension was defined as hypertension occurring at least 1 year before giving birth, as defined by the Manitoba Centre for Health Policy based on Heaman et al . Maternal hypertension was defined as hypertension occurring during the gestational period.…”