Unattended Pregnancies and Perinatal Mortality in Georgia

Abstract

Introduction

The majority of pregnant women in Georgia attend the free-of-charge, national antenatal care (ANC) programme, but over 5% of pregnancies in the country are unattended. Moreover, Georgia has one of the highest perinatal mortality (PM) rates in Europe (11.7/1000 births).

Purpose

To assess the association between unattended pregnancies and the risk of PM.

Methods

Data were extracted from the Georgian Birth Registry (GBR) and the national vital registration system. All mothers who had singleton births and delivered in medical facilities in Georgia in 2017–2018 were included in the study and categorised into attended pregnancies (at least one ANC visit during pregnancy) and unattended pregnancies (no ANC visits during pregnancy). After exclusions, the study sample included 101,663 women and their newborns, of which 1186 were either stillborn or died within 7 days. Logistic regression analysis was used to assess the effect of unattended pregnancies on PM.

Results

During the study period, the PM rate was 12.9/1000 births. In total, 5.6% of women had unattended pregnancies. The odds of PM among women with unattended pregnancies were more than double those among women with attended pregnancies (odds ratio=2.21, [95% confidence interval: 1.81–2.70]). Multiparous women with higher education and who resided/delivered outside of Tbilisi were significantly less likely to experience PM.

Conclusion

The risk of PM doubled among women with unattended pregnancies. Six percent of PM cases were attributable to unattended pregnancies. Targeting women with previous unattended pregnancies will likely reduce the PM rate in Georgia.

Keywords:

• stillbirth
• early neonatal mortality
• antenatal care
• birth registry

Policy and Practice Implications

Our study has important implications for ANC program development and future research. The major contribution of the present study is the illustration of the real effects of unattended pregnancies on PM in Georgia, as it provides actual numbers based on registry data. These numbers show that targeting women with previous unattended pregnancies could lead to a lower rate of unattended pregnancies and positively contribute to PM rates. Our results clearly underline the importance of ANC in Georgia for a better pregnancy experience. Strengthening family planning services, informing reproductive-age women about the ANC programme and about services covered by the government would also improve the rate of attended pregnancies. Finally, our study revealed several uninvestigated topics, including reasons for not attending ANC and barriers to pregnancy care, which we suggest should be the subject of future studies.

Ethics and Consent Statements

The NCDC Institutional Review Board revised and approved the study protocol (IRB # 2017-010 31.03.2017). The Regional Committee for Medical and Health Research Ethics, North Norway, approved the use of the data from the GBR for research purposes (2017/404/REK Nord).

Author Contributions

T.M. coordinated data collection, performed statistical analysis, drafted the manuscript and revised it based on other authors’ comments. C.R. conceptualized and designed data collection instruments, created the theoretical framework for the analysis, and critically reviewed the manuscript. F.E.S. conceptualized and oversaw the study, and critically reviewed the manuscript. N.K. critically reviewed the manuscript. E.E.A. conceptualized, designed, and oversaw the study, and critically reviewed the manuscript. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The project was fully funded by the Norwegian Centre for International Cooperation in Higher Education.