BMC Public Health Research article Under-attending free antenatal care is associated with adverse pregnancy outcomes Kaisa Raatikainen*, Nonna Heiskanen and Seppo Heinonen BioMed Central Open Access Address: Department of Obstetrics and Gynecology, PO Box 1777, Kuopio University Hospital, 70211 Kuopio, Finland Email: Kaisa Raatikainen* - kaisa.e.raatikainen@kuh.fi; Nonna Heiskanen - nonna.heiskanen@kuh.fi; Seppo Heinonen - seppo.heinonen@kuh.fi * Corresponding author Published: 27 September 2007 BMC Public Health 2007, 7:268 doi:10.1186/1471-2458-7-268 This article is available from: http://www.biomedcentral.com/1471-2458/7/268 Received: 9 August 2006 Accepted: 27 September 2007 © 2007 Raatikainen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Most pertinent studies of inadequate antenatal care concentrate on the risk profile of women booking late or not booking at all to antenatal care. The objective of this study was to assess the outcome of pregnancies when free and easily accessible antenatal care has been either totally lacking or low in number of visits. Methods: This is a hospital register based cohort study of pregnancies treated in Kuopio University Hospital, Finland, in 1989 – 2001. Pregnancy outcomes of women having low numbers (1–5) of antenatal care visits (n = 207) and no antenatal care visits (n = 270) were compared with women having 6–18 antenatal visits (n = 23137). Main outcome measures were: Low birth weight, fetal death, neonatal death. Adverse pregnancy outcomes were controlled for confounding factors (adjusted odds ratios, OR: s) in multiple logistic regression models. Results: Of the analyzed pregnant population, 1.0% had no antenatal care visits and 0.77% had 1– 5 visits. Under- or non-attendance associated with social and health behavioral risk factors: unmarried status, lower educational level, young maternal age, smoking and alcohol use. Chorio- amnionitis or placental abruptions were more common complications of pregnancies of women avoiding antenatal care, and pregnancy outcome was impaired. After logistic regression analyses, controlling for confounding, there were significantly more low birth weight infants in under- and non-attenders (OR:s with 95% CI:s: 9.18 (6.65–12.68) and 5.46 (3.90–7.65), respectively) more fetal deaths (OR:s 12.05 (5.95–24.40) and 5.19 (2.04–13.22), respectively) and more neonatal deaths (OR:s 10.03 (3.85–26.13) and 8.66 (3.59–20.86), respectively). Conclusion: Even when birth takes place in hospital, non- or under-attendance at antenatal care carries a substantially elevated risk of severe adverse pregnancy outcome. Underlying adverse health behavior and possible abuse indicate close surveillance of the newborn. Background The optimal amount and content of antenatal care in either low- or high-risk pregnancies is not yet resolved. There is, however, evidence showing some unquestiona- ble benefits of antenatal care [1-5] and overall, the out- come of pregnancies among women giving birth at home and without any antenatal care for religious reasons is known to be severely impaired in the US [6]. On the other Page 1 of 8 (page number not for citation purposes)