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J Korean Soc Matern Child Health > Volume 22(2); 2018 > Article
Journal of The Korean Society of Maternal and Child Health 2018;22(2):112-123.
DOI: https://doi.org/10.21896/jksmch.2018.22.2.112    Published online May 31, 2018.
The Association between Adequate Prenatal Care and Severe Maternal Morbidity: A Population-based Cohort Study
Jin Young Nam1, Eun Cheol Park2
1Institute of Health Services Research, Yonsei University, Korea
2Department of Preventive Medicine, Yonsei University College of Medicine, Korea
적정한 산전관리와 중증 모성질환 발생의 관련성 연구: 인구집단 기반 코호트 연구
남진영1, 박은철2
1연세대학교 보건정책및관리연구소
2연세대학교 의과대학 예방의학교실
Correspondence:  Jin Young Nam,
Email: ecpark@yuhs.ac
Abstract
Purpose
This study identified the relationship between adequate prenatal care and severe maternal morbidity among delivered women.
Methods
Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 91,767 cases of delivery that were delivered during 2003~2013. Severe maternal morbidity status was determined using the Center for Disease Control and Prevention’s algorithm including the diagnosis and procedure code during delivery and postpartum hospitalization. A generalized estimating equation (GEE) model with log link was performed for the relationship with severe maternal morbidity and women’s factors to estimate adjusted relative risk.
Results
Of the 91,767 delivery cases, 2,248 (2.45%) had severe maternal morbidity. In the GEE model, severe maternal morbidity was higher in women who had inadequate prenatal care than in those who had adequate prenatal care (relative risk (RR) 1.39, 95% CI 1.11~1.75, p-value 0.0045). For maternal age, women who delivered at extremely young or old ages had high risks of severe maternal morbidity, which showed a U-shaped distribution through the whole age range. Women who had the lowest level of income, who had cesarean section delivery, who were nulliparous, who had twins or more than triplet births had high risks of severe maternal morbidity.
Conclusion
Inadequate prenatal care delivery was associated with the occurrence of severe maternal morbidity. Therefore, policy makers should consider making quality indicators for early, timely, and sufficient visits during pregnancy and should monitor adequacy of prenatal care to prevent severe maternal morbidity.
Key Words: severe maternal morbidity, CDC’s SMM indicator, prenatal care, Kessner Adequacy of Prenatal Care Index


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