J Reprod Med. 2001 Jul; 46(7): 662-8.

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

Twizer I, Sheiner E, Hallak M, Mazor M, Katz M, Shoham-Vardi I.

Departments of Obstetrics and Gynecology and of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

OBJECTIVE: To examine the association between lack of prenatal care (fewer than three visits at any prenatal care facility) and perinatal complications in the Bedouin parturient population where lack of prenatal care is not associated with absence of prenatal services, substance abuse or marital status. STUDY DESIGN: The study population consisted of all Bedouin women lacking prenatal 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 prenatal 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 parity (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 comparison to the prenatal care group (1.5%, P < .001) and fewer postterm deliveries (> 42 weeks, P < .01). The incidence of low birth weight (< 2,500 g) in the no-prenatal-care group was higher than in the prenatal-care group (11.2% vs. 8.4%, P < .001). Women who did not receive adequate prenatal care had statistically 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% CI 1.2-4.5, P < .03) and postpartum fetal death (OR = 1.60, 95% CI 1.2-2.1, P < .001). Multiple logistic regression models were used to analyze the independent contribution of lack of prenatal care to perinatal mortality and to very-low-birth-weight newborns. In both models lack of prenatal care was an independent contributing factor. CONCLUSION: Lack of prenatal care is an independent contributor to perinatal mortality and low birth weight in a traditional society. In light of the high percentage of lack of prenatal care in Bedouin society, special attempts should be made to encourage women to use the available prenatal services.