A Population-Based Sample Comparing Birth Outcomes Between Different Models of Prenatal Care
Jamie A. Seabrook, PhD, Jasna Twynstra, PhD
Objectives: To compare the sociodemographic and health characteristics of pregnant individuals, based on the model of prenatal care received, and to assess differences in low birth weight (LBW), preterm birth, and macrosomia between models of prenatal care.
Methods: This retrospective cohort study consisted of a sample of 23,529 pregnant individuals from Southwestern Ontario and their birth outcomes between February 2009 and February 2014. Logistic regression models assessed the relationship between type of prenatal care provider and adverse birth outcomes.
Results: Most individuals (39.9%) received care by a family physician and obstetrician/gynecologist; 36.2% by an obstetrician/gynecologist only; 13.4% by a family physician only; 7.6% by a midwife only; 1.8% by a midwife and obstetrician/gynecologist; and 1.0% by a midwife and family physician. Patients receiving midwife-led care only were older and had higher neighbourhood-level income than patients seen by other models of care (p < .001). Patients seen by obstetricians/gynecologists only had the highest odds for LBW (aOR 1.42; 95% CI 1.13, 1.18) compared to care where midwives were involved at any point during pregnancy. However, midwife involvement in care had the highest odds for macrosomia compared to those without midwife involvement.
Conclusion: Patients receiving prenatal care by a midwife were older, had higher incomes, had a lower prevalence of LBW infants, but greater odds for fetal macrosomia, compared to other models of care.
midwifery, prenatal care, low birth weight, premature birth, fetal macrosomia, pregnancy
This article has been peer reviewed.