title: Lack of prenatal care: an independent risk factor for perinatal mortality among macrosomic newborns.
abstract: OBJECTIVE
  To examine the association between lack of prenatal care (LOPC) and perinatal complications among parturients carrying macrosomic fetuses.
  
  
  METHODS
  The study population consisted of consecutive women with singleton fetuses weighing 4 kg and above, delivered between the years 1988 and 2003. A comparison was performed between parturients lacking prenatal care (fewer than three visits at any prenatal care facility) and those with three and more prenatal care visits. A multiple logistic regression model was constructed in order to investigate the association between LOPC and perinatal mortality.
  
  
  RESULTS
  During the study period, 7,332 women delivered macrosomic newborns in our institute. Of those, 8.0% (n = 590) lacked prenatal care. Patients lacking prenatal care were more likely to be Bedouins, of higher parity and older than the comparison group. Higher rates of perinatal mortality were noted among patients lacking prenatal care (OR = 5.4, 95%CI 2.8-10.5; P < 0.001). Using a multivariable analysis and controlling for macrosomia-related complications, it was found that the association between LOPC and perinatal mortality persisted (OR = 4.1, 95% CI 2.1-8.1; P < 0.001).
  
  
  CONCLUSIONS
  Lack of prenatal care is an independent risk factor for perinatal mortality among macrosomic newborns.
authors.affiliation: Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Dickstein
authors.forename: Iris
authors.initials: I
authors.lastname: Ohel
authors.forename: Amalia
authors.initials: A
authors.lastname: Levy
authors.forename: Gershon
authors.initials: G
authors.lastname: Holcberg
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D005320:Fetal Macrosomia / Q000401:mortality*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D054238:Perinatal Mortality; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors