Unattended Pregnancies and Perinatal Mortality in Georgia

Figures & data

Figure 1 Flow chart of the study sample.

Figure 2 Directed acyclic graph presenting causal associations between perinatal mortality (PM), antenatal care (ANC) attendance, and potential confounders. GA: gestational age.

Figure 3 Perinatal mortality (PM) rate by gestational age (GA) and ANC attendance (attended pregnancies: at least one ANC visit during pregnancy; unattended pregnancies: no ANC visits during pregnancy) among singletons.

Table 1 Incidence of Early Neonatal Death (END), Stillbirth (SB), and Perinatal Mortality (PM) by Antenatal Care Attendance (Attended and Unattended Pregnancies^a).

	Attended Pregnancies N=95,957 (94.4%)	Unattended Pregnancies N=5706 (5.6%)
Incidence of
END (per 1000 livebirths), n	2.9 (276)	7.5 (42)
SB (per 1000 births), n	7.8 (746)	21.4 (122)
PM (per 1000 births), n	10.7 (1022)	28.7 (164)

Notes: ^aAttended pregnancies: at least one ANC visit during pregnancy; unattended pregnancies: no ANC visits during pregnancy.

Table 2 Maternal and Neonatal Characteristics by Singleton Perinatal Mortality (PM) Cases.

	PM Cases N=1186	Non-PM Cases N=100 477
Maternal Age, % (n)	% (n)	% (n)
≤19	3.4 (40)	3.6 (3545)
20–24	18.5 (219)	23 (23,078)
25–29	25.6 (304)	32.8 (32,941)
30–34	22.3 (264)	24 (24,224)
35–39	19.6 (233)	12.6 (12,676)
≥40	10.6 (126)	4 (4013)
Parity, % (n)^a
Primiparous	40.6 (481)	38.3 (38,476)
Multiparous	59.4 (705)	61.7 (61,963)
Education, % (n)
Primary	10.3 (122)	8.3 (8362)
Secondary	50.4 (598)	46.3 (46,538)
Higher	28.1 (333)	36.1 (36,288)
Unknown	11.2 (133)	9.3 (9289)
Regional, % (n)^b
Resided and gave birth in Tbilisi	30.1 (357)	33.1 (33,251)
Resided in Tbilisi and gave birth outside of Tbilisi	1.3 (15)	0.9 (903)
Resided outside of Tbilisi and gave birth in Tbilisi	24.5 (291)	13.9 (13,971)
Resided and gave birth outside of Tbilisi	44 (522)	52 (52,268)
Weight mean (SD)	1594 (1093)	3291 (516)
Gestational age week mean (SD)	30^+4 (5.9)	38^+4 (1.7)

Notes: ^a38 missing, ^b85 missing.

Abbreviation: SD, standard deviation.

The Georgian Birth Registry 2017–2018.

Figure 4 Map of Georgia – maternal residential regions by antenatal care attendance rates.

Table 3 Maternal and Neonatal Characteristics by ANC Attendance (Attended and Unattended Pregnancies^a).

	Attended Pregnancies N=95,957 % (n)	Unattended Pregnancies N=5706 % (n)
Maternal Age, % (n)
≤19	3 (3319)	5 (266)
20–24	23 (22,010)	22 (1287)
25–29	33 (31,563)	29 (1682)
30–34	24 (23,162)	23 (1326)
35–39	13 (12,086)	15 (823)
≥40	4 (3817)	6 (322)
Parity, % (n)^b
Primiparous	39 (37,182)	31 (1775)
Multiparous	61 (58,739)	69 (3929)
Education, % (n)
Primary	8 (7744)	13 (740)
Secondary	46 (44,631)	44 (2505)
Higher	37 (35,407)	21 (1214)
Unknown	9 (8175)	22 (1247)
Regional, % (n)^c
Resided and gave birth in Tbilisi	33 (31,682)	34 (1926)
Resided in Tbilisi and gave birth outside of Tbilisi	1 (873)	<1 (45)
Resided outside of Tbilisi and gave birth in Tbilisi	14 (13,277)	17 (985)
Resided and gave birth outside of Tbilisi	52 (50,099)	48 (2691)
Weight mean (SD)	3278 (550)	3154 (659)
Gestational age week mean (SD)	38^+4 (1.9)	38^+1 (2.7)

Notes: ^aAttended pregnancies: at least one ANC visit during pregnancy; unattended pregnancies: no ANC visits during pregnancy. ^b38 missing, ^c85 missing

Abbreviation: SD, standard deviation.

The Georgian Birth Registry 2017–2018.

Table 4 Odds Ratios and 95% Confidence Intervals for the Association Between Antenatal Care (ANC) Attendance (Attended and Unattended Pregnancies^a), Maternal Characteristics, and PM.

Perinatal Mortality	Odds Ratio (95% Confidence Interval)
ANC Attendance
Unattended pregnancy	2.21 (1.81 −2.70)
Attended pregnancy	1.0
Maternal Age
≤19	0.72 (0.49–1.05)
20–24	0.87 (0.72–1.05)
25–29	1.0
30–34	1.34 (1.13–1.60)
35–39	2.19 (1.82–2.64)
≥45	3.50 (2.78–4.42)
Parity
Primiparous	1.43 (1.25–1.63)
Multiparous	1.0
Education
Primary	1.33 (1.08–1.63)
Secondary	1.0
Higher	0.56 (0.48–0.65)
Region of Residence and Delivery
Resided and gave birth in Tbilisi	1.0
Resided in Tbilisi and gave birth outside of Tbilisi	1.49 (0.85–2.62)
Resided outside of Tbilisi and gave birth in Tbilisi	1.93 (1.63–2.29)
Resided and gave birth outside of Tbilisi	0.83 (0.72–0.98)

Notes: ^aAttended pregnancies: at least one ANC visit during pregnancy; unattended pregnancies: no ANC visits during pregnancy.