Evaluating the link between antenatal care and foetal outcomes in a rural tertiary care center in North India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20252966Keywords:
Antenatal care, Rural India, Foetal outcomes, NICU admission, Apgar score, Low birth weightAbstract
Background: Antenatal care (ANC) is essential for safeguarding the health of both mothers and newborns. Despite policy initiatives, rural India continues to face challenges in ensuring adequate and quality ANC. This study assessed the adequacy of ANC using a structured scoring system and examined its association with foetal outcomes in a rural tertiary care center in North India.
Methods: This cross-sectional study was carried out in a hospital setting, enrolling 175 mothers and their infants between August 2023 and January 2025. ANC quality was measured using a 10-domain scoring system (maximum score 40). Adequate ANC was defined as ≥24 points. Maternal and neonatal outcomes, including birth weight, Apgar scores, preterm delivery, and neonatal intensive care unit (NICU) admission, were compared between adequate and inadequate ANC groups.
Results: The mean ANC score was 24.95±8.27; 73.7% of women received adequate ANC. Adequate ANC was significantly associated with higher socioeconomic status, booked status, and caesarean deliveries (p<0.001). Neonates of inadequately supervised pregnancies had significantly higher odds of preterm birth (OR=24.8, p<0.001), low birth weight (OR=45.8, p<0.001), low Apgar score at 1 minute (OR=6.3, p=0.012), and NICU admission (OR=0.08, p<0.001).
Conclusions: Adequate ANC, as measured by a structured scoring system, was strongly associated with favourable foetal outcomes. Strengthening maternal health programs should emphasize early registration, comprehensive ANC contacts, improved record completeness, and quality counselling. Addressing socioeconomic barriers and promoting equitable access to ANC remain essential to reduce adverse outcomes in rural populations.
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References
World Health Organization. Who.int. Maternal mortality. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Accessed on 17 August 2025.
World Health Organization. Who.int. Newborn mortality. Available at: https://www.who.int/news-room/fact-sheets/detail/newborn-mortality. Accessed on 17 August 2025.
World Health Organization. Who.int. Stillbirth. Available at: https://www.who.int/health-topics/stillbirth. Accessed on 17 August 2025.
Ward ZJ, Atun R, King G, Dmello BS, Goldie SJ. Global maternal mortality projections by urban/rural location and education level: a simulation-based analysis. E-Clin Med. 2024;72:102653. DOI: https://doi.org/10.1016/j.eclinm.2024.102653
Meh C, Sharma A, Ram U, Fadel S, Correa N, Snelgrove JW, et al. Trends in maternal mortality in India over two decades in nationally representative surveys. BJOG. 2022;129(4):550-61. DOI: https://doi.org/10.1111/1471-0528.16888
Khobragade S, Khobragade Y, Abas AL. Comparative study of Perinatal Mortality, Stillbirths, and Neonatal Mortality from 2010 to 2018 in developing and developed nations with reference to Malaysia. Manipal J Med Sci. 2021;6(1):6. DOI: https://doi.org/10.55889/2582-5984.1087
Nihal S, Shekhar C. An assessment of adequate quality antenatal care and its determinants in India. BMC Pregnancy Childbirth. 2024;24(1):698. DOI: https://doi.org/10.1186/s12884-024-06806-3
Implementation of the ANC guideline and recommendations: introducing the 2016 WHO ANC model. Genève, Switzerland: World Health Organization; 2016. Available at: https://www.ncbi.nlm.nih.gov/books/NBK409109/. Accessed on 17 August 2025.
Ganapathy S, Soni B, Mishra A. Determinants of Quality Antenatal Care in Pregnant Women Using NFHS-4 Data: A Path Analysis Approach. Indian J Community Med. 2025;50(3):428-36. DOI: https://doi.org/10.4103/ijcm.ijcm_810_23
Thakkar N, Alam P, Saxena D. Factors associated with underutilization of antenatal care in India: Results from 2019-2021 National Family Health Survey. Plos One. 2023;18(5):e0285454. DOI: https://doi.org/10.1371/journal.pone.0285454
Chi H, Jung S, Subramanian SV, Kim R. Socioeconomic and geographic inequalities in antenatal and postnatal care components in India, 2016-2021. Scientific Rep. 2024;14(1):10221. DOI: https://doi.org/10.1038/s41598-024-59981-w
Gaikwad V, Bhadoriya A, Gaikwad S, Gaikwad SV. A comparative study of foetal and maternal outcomes in registered and unregistered antenatal cases in a tertiary care center. Cureus. 2024;16(8):e66066. DOI: https://doi.org/10.7759/cureus.66066
Wenling H, Jiangli D, Aiqun H, Wei Z, Huanqing H, Sidi C. Analysis of the relationship between the quality of antenatal care examinations and the incidence of preterm birth and low birth weight. BMC Public Health. 2024;24(1):3134. DOI: https://doi.org/10.1186/s12889-024-19967-9
Abebe M, Tebeje TM, Gugsa T, Kebede D, Temesgen T, Figa Z, et al. Factors associated with low fifth minute Apgar score among newborns delivered at public health facilities of Dilla town, southern Ethiopia, 2022. Int J Afr Nursing Sci. 2024;20:100656. DOI: https://doi.org/10.1016/j.ijans.2024.100656
Chekole FA, Tesfu AA, Beyene FY, Balcha WF. The effect of antenatal care on low birth weight and neonatal mortality: protocol for umbrella review of meta-analysis. J Health Populat Nutrit. 2025;44(1):146. DOI: https://doi.org/10.1186/s41043-025-00904-4
Mina MN, Nuruzzaman M, Habib MN, Rahman M, Chowdhury FM, Ahsan SN, et al. The effectiveness of adequate antenatal care in reducing adverse perinatal outcomes: evidence from a low-or middle-income country. Cureus. 2023;15(12):e51254. DOI: https://doi.org/10.7759/cureus.51254
Amponsah-Tabi S, Dassah ET, Asubonteng GO, Ankobea F, Annan JJ, Senu E, et al. An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana. Plos One. 2022;17(10):e0275933. DOI: https://doi.org/10.1371/journal.pone.0275933
Hijazi A, Althubaiti A, Al-Kadri H. Effect of antenatal care on foetal, neonatal and maternal outcomes: a retrospective cohort study. Internet J Gynecol Obstet. 2019;23(1):10-5580.
Singh S, Rathoria E, Srivastava M, Rathoria R, Bansal U, Sharma K. Impact of maternal anemia on neonatal outcomes. Int J Contemp Pediatr. 2024 Dec;11:1781-7. DOI: https://doi.org/10.18203/2349-3291.ijcp20243477
Rathoria E, Rathoria R, Bansal U, Agarwal A. Knowledge and attitude regarding breastfeeding among antenatal mothers. Sudan J Paediatr. 2025;25(1):24-36. DOI: https://doi.org/10.24911/SJP.106-1738522449
World Health Organization. Who.int. SDG target 3.1 maternal mortality. Available at: https://www.who.int/data/gho/data/themes/topics/sdg-target-3-1-maternal-mortality. Accessed on 17 August 2025.
World Health Organization. Who.int. End preventable deaths of newborns and children under 5 years of age. Available at: https://www.who.int/data/gho/data/themes/topics/sdg-target-3_2-newborn-and-child-mortality. Accessed on 17 August 2025.
Singh A, Rathoria E, Singh SK, Rathoria R, Yadav SK, Bansal U. Prevalence of overweight and obesity, and associations with socio-demographic and etiological factors. Int J Contemp Pediatr. 2024;11(10):1400-5. DOI: https://doi.org/10.18203/2349-3291.ijcp20242735
Dandona R, Kumar GA, Majumder M, Akbar M, Dora SS, Dandona L. Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India. Lancet Regional Health-Southeast Asia. 2024;25:100332. DOI: https://doi.org/10.1016/j.lansea.2023.100332
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