Maternal and fetal outcomes in the absence of antenatal care: a retrospective cohort study


  • Santi W. C. Lim Department of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore
  • Sharon A. Foo Department of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore
  • Hiu G. Chan Department of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore
  • Manisha Mathur Department of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore



Prenatal care, Maternal health services, Perinatal mortality


Background: Antenatal care plays a pivotal role in prevention, detection and treatment of pregnancy-related complications and in improving maternal and perinatal outcomes. However, few studies focus on higher income countries and no local studies have been done. This study aims to investigate these outcomes in unbooked pregnancies locally.

Methods: We conducted a retrospective single-centre cohort study of unbooked pregnant women presenting between January 2015 to December 2019. We compared indicators of maternal and perinatal outcomes between the unbooked group and women receiving routine antenatal care. Modified Poisson regression was used to test the relationship between the booking status of the pregnancy and various outcome indicators.

Results: 50,163 women delivered in the centre, 3% (n=1,525) of whom were unbooked. Unbooked women were more likely to have emergency caesarean sections and were at greater risk of delivering low birth weight babies, requiring blood transfusions (adjusted risk ratio (aRR) 2.59, CI 2.17-3.1; p<0.001) and had a 3.74-time risk of intensive care unit (ICU) admissions (CI 2.53-5.52; p<0.001). The maternal mortality rate was roughly 6 per 100,000 live births in the general population compared to 64.3 per 100,000 for the unbooked population.

Conclusions: Although the proportion of unbooked pregnancies are low, these women are more likely to have poorer outcomes and are at increased risk of neonatal morbidity and mortality. Our study highlights the importance of regular antenatal care amongst those at most risk of complications. More work is required to explore reasons for non-engagement to encourage uptake of ANC in this population.


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Original Research Articles