Based on findings associated with the WHOACT (World Health Organization Antenatal Care Trial) some countries reduced the number of prenatal visits for healthy, uneventful pregnancies from eight visits to four visits. The report showed no increased risk of health issues associated with the reduced number of prenatal visits, but a 2010 Cochrane review did not come to the same conclusion. The review claims four prenatal visits are not enough, even for healthy pregnant women. When researchers reevaluated the WHOACT, the group found increased risk of fetal death.
The Cochrane review report lead to a reevaluation of WHOACT results. When researchers took maternal risk factors like age, smoking and education into consideration, fetal death risk rose when prenatal visits were reduced. Women in the high risk pregnancy group were 80% more likely to suffer fetal death with reduced prenatal visits, but low risk women were also affected – 50% increased risk of fetal death.
There is a good chance increased risk of fetal death varies based on healthcare setting, quality of care and other contributing factors, but the correlation between number of doctor’s visits women attend and risk of fetal death is clear, no matter the contributing factors.
This is the first report to bring proof to more than 100 years of blind claims that prenatal care was crucial to pregnancy and fetal health. “After a century of blind faith, this paper provides probably the first direct evidence from a randomized trial that routine antenatal visits for healthy pregnant women do make a difference,” claims Justus Hofmeyr, professor at the University of Witwatersrand, “An increased number of routine visits may detect…pre-eclampsia, fetal growth restriction or reduced fetal movements…allowing more timely intervention.”
There is no mention of possible policy changes in countries that adopted a reduced antenatal visit schedule based on the original report from the WHOACT.
- Joshua P Vogel, Habib Abu Ndema, João Paulo Souza, Metin A Gülmezoglu, Therese Dowswell, Guillermo Carroli, Hassan S Baaqeel, Pisake Lumbiganon, Gilda Piaggio, Olufemi T Oladapo. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Reproductive Health, 2013; 10 (1): 19 DOI: 10.1186/1742-4755-10-19
- G Justus Hofmeyr, Ellen D Hodnett. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Commentary: routine antenatal visits for healthy pregnant women do make a difference. Reproductive Health, 2013; 10 (1): 20 DOI: 10.1186/1742-4755-10-20
- Science Daily