Association between adequacy of prenatal care and severe maternal
morbidity among teenage pregnancies in South Korea: a nationwide
population-based retrospective cohort study
Abstract
Objective: To study the association between the risk of severe maternal
morbidity and adequacy of prenatal care in teenage pregnancies. Design:
Population-based retrospective cohort study. Setting: National Health
Insurance Service National Delivery Cohort in Korea Population: A total
of 23,202 delivery cases including pregnant teenagers aged 13 to 19
years and gestational age ≥ 37 weeks between 2003 and 2018. Methods: We
used a generalized estimating equation model with adjustment for all
covariates to determine the adjusted relative risk (RR) associated with
severe maternal morbidity. Main Outcome Measures: severe maternal
morbidity, Kessner Adequacy of Prenatal Care Index Results: Severe
maternal morbidity occurred in 723 (3.1%) of the 23,202 delivery cases
investigated, over a 16-year period. The risk of severe maternal
morbidity was 1.8-fold higher in teenagers with inadequate prenatal care
(RR 1.81, 95% confidence interval [CI] 1.39– 2.37) and 1.6-fold
higher in those with intermediate prenatal care (RR 1.59, 95% CI
1.33–1.87) than in those with adequate prenatal care. Synergistic
effects of inadequate prenatal care and maternal comorbidity were
observed on severe maternal morbidity. Conclusion: This study confirmed
that inadequate prenatal care was associated with the risk of severe
maternal morbidity among pregnant teenagers. Notably, maternal
comorbidity and inadequate prenatal care produced synergistic effects on
severe maternal morbidity. Therefore, public health policy makers should
focus on the development and implementation of programs to ensure
adequate prenatal care and support financial accessibility of healthcare
to improve teenage mothers’ health.