Quality of first antenatal care visits and perinatal outcomes

Evidence from a cohort study in Ethiopia, Kenya, South Africa, and India

Bibliographic Data

ID19591445
AuthorsWen-Chien Yang (0000-0001-8206-1496, Milken Institute), Shalom Sabwa (0000-0001-7121-1807, Emory University), Anagaw Derseh Mebratie (0000-0002-6489-335X, Addis Ababa University), Beatrice Amboko (0000-0002-5754-3853, Kenya Medical Research Institute), Irene Mugenya (0000-0003-4827-5241, Kenya Medical Research Institute), Sein Kim (0000-0002-4475-3878, Harvard Global Health Institute), Emily R Smith (0000-0001-5715-9459, Milken Institute), Monica Chaudhry (0000-0002-8795-1815, Public Health Foundation of India), Nokuzola Cynthia Mzolo (University of KwaZulu-Natal), Nompumelelo Gloria Mfeka-Nkabinde (0000-0001-9176-7626, Howard College), Theodros Getachew (Ethiopian Public Health Institute), Theodros Getachew Zemedu (0000-0002-6486-0531), Tefera Taddele (0000-0002-2327-136X, Ethiopian Public Health Institute), Damen Haile Mariam (0000-0002-3229-5259, Addis Ababa University), Sailesh Mohan (0000-0003-1853-3596, Public Health Foundation of India), Prashant Jarhyan (0000-0002-5020-3995, Centre for Chronic Disease Control), Margaret E Kruk (0000-0002-9549-8432, Washington University in St. Louis), Catherine Arsenault (0000-0003-2410-3015, Milken Institute, corresponding author)
EditorsNicola L Hawley (0000-0002-2601-3454)
Year2026
Volume6
Issue4
Pagese0006248
Publication date2026-04-13
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0006248
PMID41973714
OpenAlexW7154166967
LanguageEN
References cited40

Antenatal care (ANC) is crucial for maternal and newborn health. Although ANC coverage has improved globally, ANC quality remains suboptimal. This study assessed the quality of first ANC visits and their association with perinatal outcomes. We used data from the eCohort study that collected longitudinal data on ANC utilization and quality until the end of pregnancy in Ethiopia, Kenya, South Africa, and India. Perinatal outcomes of interest included fetal losses (miscarriages ≥13 weeks of gestation or stillbirths) and low birth weight (LBW) newborns. Good quality ANC at first visits was defined as receiving six essential care components: blood pressure measurement, blood and urine tests, ultrasound, iron and folic acid supplementation, and counseling on pregnancy danger signs. We conducted mixed-effect logistic regressions to assess associations between good quality ANC and perinatal outcomes, with sensitivity analyses where good quality ANC excluded ultrasound scans. Among 3,600 pregnant women followed until the end of pregnancy, 5.8% received all six components at their first visits (from 1.3% in India to 14.0% in Ethiopia), and 30.7% received five components (5.7% in India to 52.5% in Kenya). Between 3.7% of women in Ethiopia and 6.3% in India experienced a fetal loss. Between 8.5% of newborns in Ethiopia and 16.3% in India were born LBW. Good quality ANC at first visits was associated with a 32% to 59% lower risk of fetal loss (primary analysis: risk ratio (RR) 0.41, 95% confidence interval (CI) 0.10–0.72; sensitivity analysis: RR 0.68, 95% CI 0.44–0.92). No significant associations were observed between good quality ANC and LBW. This study identified important gaps in ANC quality and found that good quality ANC is associated with a lower fetal loss risk. Investments must be made to improve ANC quality and ensure the delivery of essential care in pregnancy

Birth weight · Cohort · Cohort study · Confidence interval · Gestation · Logistic regression · Low birth weight · Pregnancy · Prenatal care · Child Nutrition and Water Access · Global Maternal and Child Health · Maternal and Neonatal Healthcare