Prenatal care and child growth and schooling in four low- and medium-income countries.
BACKGROUND
The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries.


METHODS
We pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood.


RESULTS
Among 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations.


CONCLUSIONS
While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.
Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Xiaoying
http://orcid.org/0000-0001-9897-1291
X
Liu
Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Jere R
JR
Behrman
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.|University of the Witwatersrand / Medical Research Council Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Aryeh D
AD
Stein
Department of Nutrition, University of North Carolina at Chapel Hill, United States of America.
Linda S
LS
Adair
Department of Pediatrics, S.L. Jain Hospital, Delhi, India.
Santosh K
SK
Bhargava
USC-Office of Population Studies Foundation, Inc., and Department of Nutrition and Dietetics, University of San Carlos, Cebu City, Philippines.
Judith B
JB
Borja
Post-Graduation Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Brazil.
Mariangela Freitas
MF
da Silveira
Post-Graduation Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Brazil.
Bernardo L
BL
Horta
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Reynaldo
R
Martorell
University of the Witwatersrand / Medical Research Council Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Shane A
SA
Norris
University of the Witwatersrand / Medical Research Council Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.|University of the Witwatersrand, DST-NRF Centre of Excellence in Human Development, Johannesburg, South Africa.
Linda M
LM
Richter
Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
Harshpal S
HS
Sachdev
D002648:Child; D002657:Child Development; D003906:Developing Countries / Q000706:statistics & numerical data*; D004493:Education / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012574:Schools