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Assessing the Effect on Outcomes of Public or Private Provision of Prenatal Care in Portugal

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Abstract

To evaluate whether public and private prenatal care users experience similar outcomes, taking into consideration maternal pre-pregnancy social and clinical risk. We studied 7,325 women who delivered single newborns at five public maternity units in Porto, Portugal. Health behaviors and prenatal care were self-reported; pregnancy complications and delivery data were retrieved from medical files. The odds of inadequate weight gain, continuing to smoke, gestational hypertension, gestational diabetes, caesarean section, preterm birth, low birthweight, and small- and large-for-gestational-age were estimated for public and private providers using logistic regression, stratified by pre-pregnancy risk profile, adjusted for maternal characteristics. 38 % of women used private prenatal care. Among low-risk women, public care users were more likely to gain excessive weight (OR 1.26; 95 % CI 1.06–1.57) and be diagnosed with gestational diabetes (OR 1.37; 95 % CI 1.01–1.86). They were less likely to have a caesarean (OR 0.63; 95 % CI 0.51–0.78) and more likely to deliver small-for-gestational-age babies (OR 1.48; 95 % CI 1.19–1.83). Outcomes were similar in high-risk women although preterm and pre-labor caesarean were less frequent in public care users (OR 0.64 95 % CI 0.45–0.91; OR 0.69 95 % CI 0.49–0.97). The amount of care was not significantly related to risk profile in either case. Public care users experienced similar outcomes to those using private care, despite higher pre-pregnancy disadvantage. Low-risk women need further attention if narrowing inequalities in birth outcomes remains a priority.

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Acknowledgments

The authors gratefully acknowledge the families enrolled in Generation XXI for their kindness, all members of the research team for their enthusiasm and perseverance and the participating hospitals and their staff for their help and support. This project was funded by Programa Operacional de Saúde – Saúde XXI, Quadro Comunitário de Apoio III and by Administração Regional de Saúde Norte (Regional Department of Ministry of Health). This work was supported by the Portuguese Foundation for Science and Technology (Grant SFRH/BD/66159/2009).

Conflict of interest

The authors report no conflict of interest.

Ethical standard

The birth cohort study was approved by the ethics committee from the University of Porto Medical School/Hospital S. João (27th April 2005) and a written signed consent form, designed according to the Declaration of Helsinki, was required for all women.

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Authors and Affiliations

  1. EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas, 135-139, 4050-091, Porto, Portugal

    Sofia Correia, Teresa Rodrigues & Henrique Barros

  2. Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal

    Sofia Correia, Teresa Rodrigues & Henrique Barros

  3. Department of Gynaecology and Obstetrics, Hospital Sao Joao-EPE, Porto, Portugal

    Teresa Rodrigues

Authors
  1. Sofia Correia
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  2. Teresa Rodrigues
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Correspondence to Sofia Correia.

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Correia, S., Rodrigues, T. & Barros, H. Assessing the Effect on Outcomes of Public or Private Provision of Prenatal Care in Portugal. Matern Child Health J 19, 1574–1583 (2015). https://doi.org/10.1007/s10995-015-1667-4

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