Lack of prenatal care in a traditional society - Is it an obstetric hazard?

OBJECTIVE: To examine the association between lack of prenatal care (fewer than three visits at any prenatal care facility) and perinatal complication s in the Bedouin parturient population where lack of prenatal care is not a ssociated with absence of prenatal services, substance abuse or marital sta tus. STUDY DESIGN: The study population consisted of all Bedouin women lacking p renatal care (n = 7,601) who gave birth between the years 1990-1997 in the Soroka University Medical Center. The analysis consisted of a comparison of labor and delivery outcomes in women without prenatal care to outcomes in women who had some prenatal care. RESULTS: During the years 1990-1997 there were 36,281 singleton deliveries to Bedouin women at our institution. Of those, 20.9% did not receive prenat al care. Mothers in the no-prenatal-care group tended to be in the extremes of their reproductive Cycles (<18 years, >35 years) and were of higher par ity (P<.001) than those receiving prenatal care. There were more deliveries prior to 32 weeks of gestation in the no-prenatal-care group (2.8%) in com parison to the prenatal care group (1.5%, P<.001) and fewer postterm delive ries (> 42 weeks, P<.01). The incidence of low birth weight (<2,500 g) in t he no-prenatal-care group was higher than in the prenatal-care group (11.2% vs. 8.4%, P<.001). Women mho did not receive adequate prenatal care had st atistically significantly higher rates of antepartum fetal death (OR = 1.8, 95% CI 1.4-2.3, P<.001), intrapartum fetal death (OR = 2.38, 95% Cl 1.2-4. 5, P<.03) and postpartum fetal death (OR =1.60, 95% CI 1.2-2.1, P<.001). Mu ltiple logistic regression models were used to analyze the independent cont ribution of lack of prenatal care to perinatal mortality and to very-low-bi rth-weight newborns. In both models lack of prenatal care was all independe nt contributing factor. CONCLUSION: Lack of prenatal care is all independent contributor to perinat al mortality and low birth weight in a traditional society. In light of the high percentage of lack of prenatal care in Bedouin society, special attem pts should be made to encourage women to use the available prenatal service s.