Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Number of prenatal visits and pregnancy outcomes in low-risk women



We investigated the association between number of prenatal visits (PNV) and pregnancy outcomes.

Study Design:

A retrospective cohort of 12 092 consecutive, uncomplicated term births was included. Exclusion criteria included unknown or third trimester pregnancy dating, pre-existing medical conditions and common pregnancy complications. Patients with 10 PNV were compared with those with >10. The primary outcome was a neonatal composite including neonatal intensive-care unit admission, low APGAR score (<7), low umbilical cord pH (<7.10) and neonatal demise. Secondary outcomes included components of the composite as well as vaginal delivery, induction and cesarean delivery. Logistic regression was used to adjust for potential confounders.


Of 7256 patients in the cohort meeting inclusion criteria, 30% (N=2163) had >10 PNV and the remaining 70% (N=5093) had 10, respectively. There was no difference in the neonatal composite between the two groups. However, women with>10 PNV were more likely to undergo induction of labor and cesarean delivery.


Low-risk women with 10 PNV had higher rates of pregnancy interventions without improvement in neonatal outcomes.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Figure 1


  1. Rosen MG, Merkatz IR, Hill JG . Caring for our future: a report by the expert panel on the content of prenatal care. Obstet Gynecol 1991; 77 (5): 782–787.

    CAS  PubMed  Google Scholar 

  2. Vlllar J . Scientific basis for the content of routine antenatal care I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. Acta Obstet Gynecol Scand 1997; 76 (1): 1–14.

    Article  Google Scholar 

  3. Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev 2010; (10): CD000934.

  4. American Academy of Pediatrics ACoO, Gynecologists. Guidelines for perinatal care 2012. Available at:

  5. Alexander GR, Kotelchuck M . Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research. Public Health Rep 2002; 116 (4): 306–316.

    Article  Google Scholar 

  6. Buekens P, Kotelchuck M, Blondel B, Kristensen FB, Chen JH, Masuy-Stroobant G . A comparison of prenatal care use in the United States and Europe. Am J Public Health 1993; 83 (1): 31–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. MacDorman MF, Matthews TJ, Mohangoo AD, Zeitlin J . International comparisons of infant mortality and related factors: United States and Europe, 2010. Natl Vital Stat Rep 2014; 63 (5): 1–6.

    PubMed  Google Scholar 

  8. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 101: ultrasonography in pregnancy. Obstet Gynecol 2009; 113 (2, Part 1): 451–461.

    Article  Google Scholar 

  9. Kogan MD, Martin JA, Alexander GR, Kotelchuck M, Ventura SJ, Frigoletto FD . The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices. JAMA 1998; 279 (20): 1623–1628.

    Article  CAS  PubMed  Google Scholar 

  10. Kotelchuck M . The adequacy of prenatal care utilization index: its US distribution and association with low birthweight. Am J Public Health 1994; 84 (9): 1486–1489.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kotelchuck M . An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84 (9): 1414–1420.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Haas JS, Udvarhelyi S, Epstein AM . The effect of health coverage for uninsured pregnant women on maternal health and the use of cesarean section. JAMA 1993; 270 (1): 61–64.

    Article  CAS  PubMed  Google Scholar 

  13. Housden L, Wong ST, Dawes M . Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ 2013; 185 (13): E635–E644.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol 2007; 110 (2 Pt I): 330–339.

    Article  PubMed  PubMed Central  Google Scholar 

  15. McDuffie RS Jr, Beck A, Bischoff K, Cross J, Orleans M . Effect of frequency of prenatal care visits on perinatal outcome among low-risk women: a randomized controlled trial. JAMA 1996; 275 (11): 847–851.

    Article  PubMed  Google Scholar 

  16. Petrou S, Kupek E, Vause S, Maresh M . Antenatal visits and adverse perinatal outcomes: results from a British population-based study. Eur J Obstet Gynecol Reprod Biol 2003; 106 (1): 40–49.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to E B Carter.

Ethics declarations

Competing interests

Dr Carter is supported by a NIH T32 training grant (5T32HD055172-05). Dr Cahill was a Robert Wood Johnson Foundation Physician Faculty Scholar, who partially supported this work.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carter, E., Tuuli, M., Caughey, A. et al. Number of prenatal visits and pregnancy outcomes in low-risk women. J Perinatol 36, 178–181 (2016).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links