First trimester antenatal care visit reduces the risk of miscarriage among women of reproductive age in Ghana
), Samuel K Essien(2), Carl D’Arcy(3),
(1) Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
(2) School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
(3) School of Public Health and Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Corresponding Author
Abstract
Miscarriage is a common adverse pregnancy outcome in childbearing and an increasing global reproductive health problem. This study explored 1) the national prevalence of the first trimester (≤12 weeks) miscarriage among women (15-49 years) in Ghana, and 2) the influence of first-trimester antenatal care (ANC) visits on miscarriage risk. A cross-sectional study using the Demographic Health Survey (DHS- 2017) on maternal health in Ghana was conducted. We used a nationally representative subsample of (7,846) women with no or early ANC visit of the initial sample (25,062). Women with late ANC visit (≥12 weeks) and those who were never pregnant or had not given birth at the time of the survey were excluded from this analysis. We performed multivariable Poisson regression to estimate miscarriage risk (RR), its associated risk factors, and national prevalence. The national first-trimester miscarriage prevalence was 19.1%. Increasing maternal age and urban residence were significantly associated with the risk of first-trimester miscarriage (p<0.001) while early ANC visits lower the risk of miscarriage by 43% (p=0.0246). We found that first trimester ANC visit decreases miscarriage risk in Ghana and highlights the important role of early ANC visits in reducing miscarriages. (Afr J Reprod Health 2021; 25[1]: 129-137).
References
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers
C, Hogan D, Flenady V,Frøen JF, Qureshi ZU, Calderwood C, Shiekh S, Jassir FB, You D, McClure EM, Mathai M and Cousens S. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016; 387:587–603.
Kiguli J, Munabi IG, Ssegujja E, Nabaliisa J, Kabonesa
C, Kiguli S and Josaphat B. Stillbirths in sub-Saharan Africa: unspoken grief. Lancet 2016; 387: e16–18.
Modvig J, Schmidt L and Damsgaard MT. Measurement
of total risk of spontaneous abortion: the virtue of conditional risk estimation. Am J Epidemiol 1990; 132:1021–38.
Lok IH, and Nuegebauer R. Psychological morbidity
following miscarriage. Best Pract & Res Clin Obstetr and Gynae 2007; 21(2): 229–47.
Ammon Avalos L, Galindo C and Li DK. A systematic
review to calculate background miscarriage rates using life table analysis. Birth Defects Res Part A Clin Mol Teratol 2012; 94:417–23.
Wilcox AJ, Weinberg CR, O’Connor JF,Baird DD,
Schlatterer JP, Canfield RE, Armstrong EG and Nisula BC. Incidence of early loss of pregnancy. N Engl J Med 1988; 319:189–94.
Zinaman MJ, Clegg ED, Brown CC,O'Connor J and
Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril1996; 65:503–9.
Ellish NJ, Saboda K, O’Connor J,Nasca PC, Stanek EJ
and Boyle C. A prospective study of early pregnancy loss. Hum Reprod 1996; 11:406–12.
Ota E, Tobe-Gai R, Mori R and Farrar D. Antenatal
dietary education and supplementation to increase energy and protein intake. Cochrane Database Sys Rev 2015. 12;(9):CD000032.
Peña-Rosas JP, De-Regil LM, Garcia-Casal MN and
Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2015; 22;(7):CD004736
Haider BA, and Bhutta ZA. Multiple-micronutrient
supplementation for women during pregnancy. Cochrane Database Sys Rev 2017; 13;4:CD004905
de Jongh TE, Gurol-Urganci I, Allen E,Zhu NJ and Atun
R. Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review. J Glob Health 2016; 6:010403.
McNellan CR, Dansereau E, Colombara D, Palmisano E,
Wallace M, Johanns C, Schaefer A, Ríos-Zertuche D, Zúñiga-Brenes P, Hernandez B, Iriarte E and Mokdad A. Uptake of antenatal care, and its relationship with participation in health services and behaviors: an analysis of the poorest regions of four Mesoamerican countries. Ann Glob Health 2017; 83:193–4.
Chen XK, Wen SW, Yang Q, and Walker MC.
Adequacy of prenatal care and neonatal mortality in infants born to mothers with and without antenatal high-risk conditions. Aust N Z J Obstet Gynaecol 2007; 47:122–27.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, and Van
Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367:1066–74.
Lincetto O, Mothebesoane A, Gomez P, Munjanja S.
Chapter 2: Antenatal care. In: Lawn J, Kerber K, editors. Opportunities for Africa’s Newborns: practical data, policy and programmatic support for newborn care in Africa. Geneva: World Health Organization; 2006. [Internet]. http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf. [Accessed 19 January 2020]. pp. 51–62.
World Health Organization. WHO statement on
antenatal care. Geneva, Switzerland: World Health Organization 2011. [Internet].https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf;jsessionid=B3E79DE27EAA0D7308A97A59E1CDC119?sequence=1. [Accessed 19 January 2020].
Sibeko S and Moodley J. Healthcare attendance patterns
by pregnant women in Durban, South Africa. South African Fam Pract 2006; 48(10):17±17e.
Banda I, Michelo C and Hazemba A. Factors associated
with late antenatal care attendance in selected rural and urban communities of the copper belt province of Zambia. Med J Zambia. 2014; 39(3):29±36.
Gudayu TW, Woldeyohannes SM and Abdo AA. Timing
and factors associated with first antenatal care booking among pregnant mothers in Gondar Town; North West Ethiopia. BMC Preg Childbirth 2014; 14(1).
Manzi A, Munyaneza F, Mujawase F, Banamwana L,
Sayinzoga F, Thomson DR, Ntaganira J and Hedt-Gauthier BL. Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010. BMC Preg Childbirth 2014; 14(1): 287.
Ndidi E and Oseremen I. Reasons given by pregnant
women for late initiation of antenatal care in the Niger Delta, Nigeria. Ghana Med J 2011; 44(2): 47–51.
Kisuule I, Kaye DK, Najjuka F, Ssematimba SK, Arinda
A, Nakitende G and Otim L. Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda. BMC Preg Childbirth 2013; 13(1):121.
Millennium Development Goals Indicators. [Internet].
http://mdgs.un.org/unsd/mdg/Metadata.aspx?IndicatorId=0&SeriesId=762. [Accessed January 18, 2020].
World Health Organization. Reproductive health
indicators: guidelines for their generation, interpretation and analysis for global monitoring. Geneva: World Health Organization, 2006. [Internet].https://apps.who.int/iris/handle/10665/43185. [ Accessed 19 January 2020].
Pell C, Meñaca A, Were F, Afrah NA, Chatio S, Manda-
Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P, and Pool R. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS ONE 2013; 8: e53747.
Dellicour S, Aol G, Ouma P, Yan N, Bigogo G, Hamel
MJ, Burton DC, Oneko M, Breiman RF, Slutsker L, Feikin D, Kariuki S, Odhiambo F, Calip G, Stergachis A, Laserson KF, O ter Kuile F and Desai M. Weekly miscarriage rates in a community-based prospective cohort study in rural western Kenya. BMJ Open 2016; 6: e011088.
Kuhnt J and Vollmer S. Antenatal care services and its
implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open 2017; 7: e017122.
Xue T, Zhu T, Geng G and Zhang Q. Association
between pregnancy loss and ambient PM2.5 using survey data in Africa: a longitudinal case-control study, 1998-2016. Lancet Planet Health 2019; 3: e219–25.
De Bernis L, Kinney MV, Stones W,Ten Hoope-Bender
P, Vivio D, Leisher SH, Bhutta ZA, Gülmezoglu M, Mathai M, Belizán JM, Franco L, McDougall L, Zeitlin J, Malata A, Dickson KE and Lawn JE . Stillbirths: ending preventable deaths by 2030. Lancet 2016; 387: 703–16.
Ghana Statistical Service - GSS, Ghana Health Service –
GHS and ICF, Ghana Maternal Health Survey. GSS, GHS, and ICF: Accra, Ghana. 2017.[Internet]. https://www.dhsprogram.com/pubs/pdf/FR340/FR340.pdf. [Accessed 18 January 2020].
The Demographic and Health Surveys. 2017. [Internet].
https://www.dhsprogram.com/publications/publication-fr340-other-final-reports.cfm. [Accessed 18 January 2020].
Kyei NNA, Campbell OMR and Gabrysch S. The
influence of distance and level of service provision on antenatal care use in rural Zambia. PloS one 2012; 7(10): e46475–e46475.
Kianifard F and Gallo PP. Poisson regression analysis in
clinical research. J Biopharmaceutical Stat 1995; 5(1): 115–29.
Coxe S, West SG and Aiken LS. The Analysis of Count
Data: A Gentle Introduction to Poisson Regression and Its Alternatives. J Personality Assess 2009; 91(2):121–36.
Hanley JA, Negassa A, Edwardes MD and Forrester JE.
Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epi 2003; 157(4): 364–75.
Shults J and Hilbe JM. Quasi-least squares regression.
: Chapman and Hall/CRC.
Hosmer DW, Lemeshow S and Cook E. Applied logistic
regression 2nd edition. NY: John Wiley & Sons, 2000.
Kamangar F. Confounding variables in epidemiologic
studies: basics and beyond. Arch Iran Med 2012; 15(8): 508–16.
Chimatiro CS, Hajison P, Chipeta E and Muula
AS .Understanding barriers preventing pregnant women from starting antenatal clinic in the first trimester of pregnancy in Ntcheu District-Malawi. Reprod health 2018; 15(1): 158.
Phengsavanh A, Laohasiriwong W, Suwannaphant K,
Assana S, Phajan T and Chaleunvong K. Antenatal care and its effect on risk of pregnancy induced hypertension in Lao PDR: A case-control study. F1000Research 2018; 7:1236.
Magadi MA, Madise NJ and Rodrigues RN. Frequency
and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med 2000; 51(4): 551–61.
Nwameme AU, Tabong PTN and Adongo PB.
Implementing Community-based Health Planning and Services in impoverished urban communities: health workers’ perspective. BMC health serv res 2018; 18(1):186.
de La Rochebrochard E and Thonneau P. Paternal age
and maternal age are risk factors for miscarriage, results of a multicentre European study. Human reprod 2002; 17(6): 1649–56.
Cohain JS, Buxbaum RE and Mankuta D. Spontaneous
first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more. BMC Preg Childbirth 2017; 17(1):437.
Stokes E, Dumbaya I, Owens S and Brabin L. The right
to remain silent: a qualitative study of the medical and social ramifications of pregnancy disclosure for Gambian women. BJOG 2008;115 (13):1641–1647.
Pal AK, Amulkar PS, Waghmare JE, Wankhede V,
Shende MR and Tarnekar AM. Chromosomal Aberrations in Couples with Pregnancy Loss: A Retrospective Study. J human reprod sci 2018; 11(3): 247–53.
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