Does lack of prenatal care predict later lack of child care?

Objective
To investigate the impact of maternal lack of prenatal care (LOPC) on long-term morbidity of the offspring in a traditional society.

Study Design
A population based cohort analysis was performed comparing the incidence of long-term morbidity (up to the age of 18) of children sharing the same ethnic origin, born following pregnancies with and without LOPC. Morbidity included hospitalizations involving a pre-defined set of ICD-9 codes, including cardiovascular, respiratory, neurology, hematology, infectious and gastrointestinal (GI) related hospitalizations (according to hospital records). Deliveries occurred between the years 1988-2013 in a tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded from the analysis. Kaplan-Meier curves were constructed to compare cumulative morbidity in both groups. A cox proportional hazards model was used to control for confounders.

Results
During the study period, 127 396 newborns met the inclusion criteria; 15% (n=19 173) of which were born following pregnancies without prenatal care. Hospitalizations of offspring up to the age of 18, involving GI, respiratory, neurology, hematology and infectious morbidities were significantly less common in offspring of mother with no prenatal care (p<0.001; Table). The survival curves demonstrated significantly lower cumulative incidence of all, but cardiovascular, morbidities in the LOPC vs. the routine prenatal care group (Figure, log rank p<0.05). In the Cox regression model, controlling for maternal age at birth, preterm delivery and birthweight, LOPC was associated with lower hospitalization rate of the offspring in almost all categories assessed (aHR in table).

Conclusion
Lack of prenatal care appears to predict lower pediatric hospitalization rate of the offspring, possibly as a result of lack of child health care.