Factors Associated with Maternal-Fetal Morbidity in Prenatal Care

Research Article

J Fam Med. 2018; 5(2): 1136.

Factors Associated with Maternal-Fetal Morbidity in Prenatal Care

Gonzalez-Mascare&nTilde;o DC1, Soto-Acevedo F2, Medina-Serrano JM3, Castro-Cervantes LE1, Bernal-Benitez LC1 and Ramirez-Leyva DH4*

¹Department of Family Medicine, Family Medicine Unit #46 (IMSS), Sinaloa Delegation, Mexico

²Department of Family Medicine, Family Medicine Unit #47 (IMSS), Guanajuato Delegation, Mexico

³Medical Coordinator and Health Research, Sinaloa Delegation (IMSS), Mexico

4Department of Family Medicine, Family Medicine Unit #18 (IMSS), Baja California Delegation, Mexico

*Corresponding author: Ramirez-Leyva Diego Hazael, Department of Family Medicine, Family Medicine Unit #18 (IMSS), Baja California Delegation, México

Received: January 21, 2018; Accepted: February 12, 2018; Published: February 19, 2018


Background: The prenatal care is a set of actions that involves a series of visits of the pregnant woman to the health institution, with the objective of monitoring the evolution of pregnancy, detecting risks, preventing complications and preparing her for childbirth and maternity. The quality of prenatal care plays an important role in the outcome of pregnancy as well as maternal-fetal morbidity.

Aim: The purpose of this study is to determinate the factors associated with maternal-fetal morbidity in prenatal care.

Design and Setting: Comparative cross-sectional study.

Methods: In 66 patients in the Family Medicine Unit #46, Culiacan, Sinaloa, Mexico. The patients were divided into two groups, with maternal-fetal morbidity and without maternal-fetal morbidityto make an association in search of associated factors in prenatal care.In addition, a logical correlation was made between the variables studied; it was used 95% statistical power and 95% interval confidence; association was established by calculating odds ratios, chisquared test and Spearman for statistical significance (p‹0.05).

Results: The association between maternal-fetal morbidity and associated factors reported the following results: age [OR = 1.7, p 0.30], body mass index [OR=3.7, p 0.01], scholarship [OR=1.1, p 0.82], occupation [OR=0.5, p 0.22], number of consultations [OR=0.9, p 0.90], obstetric risk [OR=0.8, p 0.69], quality of prenatal care [OR=1.1, p 0.77], way of birth [OR=1.2, p 0.69], comorbidities [OR=22.2, p 0.001], previous caesarean [OR=0.1, p 0.04]. The correlations found were mostly weak.

Conclusion: There are two variables that are important risk factors for developing maternal-fetal morbidity, obesity in pregnancy and the presence of comorbidities before pregnancy. Both variables are susceptible to modify, allowing the reduction of adverse maternal-fetal events.

Keywords: Prenatal care; Maternal-Fetal Morbidity; Pregnancy


The risk approach is an instrument to identify the priority problems that contribute to perinatal morbidity and mortality in the different levels of attention. This strategy also works to distribute the resources required, proposing strategies that show benefits in the obstetric patient, as well as in the reduction of perinatal mortality (week 22 of pregnancy to the first seven days of life). Risk factors of the mother and child can be identified during prenatal care; many are preventable or modifiable by actions that will favor satisfactory results in maternal and child health [1]. The statistics of maternal and fetal morbidity and mortality in developing countries reflect the consequences of not providing good prenatal care. Traditionally, prenatal care programs (PNC) have been recommended in developing countries following the guidelines of programs used in developed countries, incorporating only minor adaptations according to local conditions [2].

Maternal and child health care is a priority for health services, its main objective is the prevention of maternal complications in pregnancy, timely diagnosis and adequate care. The main causes of maternal and perinatal mortality are preventable through early, systematic and high quality prenatal care, which allows identifying and controlling the main obstetric and perinatal risk factors [3]. WHO considers that only 63% of pregnant women in Africa, 65% in Asia and 73% in Latin America attend at least one prenatal care visit, among the factors associated with low adherence to prenatal care are: age, low socioeconomic level, multiparity, low educational level, lack of a stable partner, financial barriers, lack of health insurance and physical abuse [4].

The objectives of prenatalcare are: evaluate the health status of the mother and fetus, establish the gestational age, evaluate possible risks, plan prenatal care and indicate folic acid as soon as possible, for the prevention of neural tube defects. The recommended frequency for an uncomplicated pregnancy is every 4 weeks during the first 28 weeks, every 2-3 weeks between week 28 to week 36 and weekly after 36 weeks [5]. Despite the above the purpose of this study is to determinate the factors associated with maternal-fetal morbidity in prenatal care.

Materials and Methods

A comparative cross-sectional study was carried out, in the Family Medicine Unit #46, of the Mexican Institute of Social Security (IMSS), located in Culiacan, Sinaloa, Mexico; in pregnant patients which were selected by a consecutive sampling techniques; that met the following inclusion criteria: any age, that accepted and signed the informed consent and with at least one medical consultation of prenatal care; were eliminated those who did not complete the survey or those with incomplete information. The following data were obtained directly from the patients or medical records: age, adherence to the clinical practice guide of prenatal care, comorbidities, nutritional status, schooling, number of consultations, obstetric risk, occupation, way of birth and previous cesarean.Patients were assigned to two groups based on maternal-fetal morbidity, which was considered as any adverse event occurred during pregnancy for the mother or fetus. The adherence to the clinical practice guide of prenatal care was measured with the unique prenatal care evaluation card developed by IMSS, this card divides the prenatal care into satisfactory prenatal care when the result is greater than 80 percent and unsatisfactory prenatal care when the result is less than 80 percent.

The data obtained was integrated into data collection sheets and analyzed using the SPSS program version 20 in Spanish, where we applied descriptive statistics; for qualitative variables frequencies and percentages were used and for quantitative variables mean and standard deviation were used. It was considered statistically significant a p ‹0.05, with a 95% confidence interval, all variables were dichotomized to apply odds ratio and chi square. A logic correlation with Spearman was used between the variables studied; the Protocol was authorized by the Local Committee of Research and Ethics in Health Research from the Family Medicine Unit #46, where the study took place.


A sample of 72 patients was analyzed, 6 of whom had incomplete information (9.0%), obtaining a total of 66 patients, the mean age of patients (Table 1) was 27.64 years (SD ±5.7), it was found that most of the participants were less than 30 years old (60.6%) compared to those older than 30 years (39.4%). When performing descriptive statistics of sociodemographic variables (Table 2) we found that most of the patients had a bachelor's degree (40.9%) compared to the other levels that included high school (25.8%), secondary (19.7%), primary (9.1%) and technical career (4.5%) in that order of frequency. In the occupation (Table 2) it was found that 62% are active workers and 38% are housewives. Regarding the marital status, most of the patients were married (53%) compared to the free union (30%) and unmarried (17%). When measuring the obstetric clinical variables (Table 2), in relation to the body mass index it was found that most of patients at the beginning of pregnancy were overweight (37.9%), followed by normal weight (25.8%), obesity grade 2 (18.2%), obesity grade 1 (13.6%) and obesity grade 3 (4.5%).