Poor antenatal care in 20 French districts: risk factors and pregnancy outcome

Study objective-Poor attendance to antenatal visits was studied to identify risk factors and to analyse the association with adverse pregnancy outcome. Design-All poor attenders and a sample of good attenders were compared within three groups of women: women < 20 years, French women greater than or equal to 20 years, and foreigners greater than or equal to 20 years. Setting-20 French districts including 85 000 births from January to June 1993. Subjects-848 poor attenders and 759 good attenders. Poor attenders made fewer than four antenatal visits or began care during or after the sixth month. Good attenders made at least four visits and began care before the sixth month. Main results-1.1% of the women were poor attenders. Risk factors for poor attendance were single status and lack of health insurance in the group under 20; young age, high parity, and single status in the French group aged over 20; and single status and lack of health insurance in the foreign group aged over 20. For attenders, the odds ratios for preterm delivery were 5.8 (95% CI: 3.2, 10.5) among French women and 3.3 (95% CI: 1.5, 7.4) among foreign women with health insurance. Poor attendance was not associated with poor pregnancy outcome in the group under 20, and among foreign women over 20 without health insurance, but both groups had high rates of preterm delivery and low birth weight. Conclusion-Lack of health insurance is an important barrier to health care during pregnancy. Poor antenatal care is an important risk factor for adverse pregnancy outcome among women who have easy access to health care services.