(B-256) Sociodemographic Determinants and Inequities in Prenatal Healthcare in the Canadian province of Manitoba: A Population-Based Cohort Study (2010-2022)

Background: Access to prenatal care (PNC) services is essential for the health and safety of mothers and their infants, as it helps reduce complications and adverse pregnancy outcomes. Exploring the clinical and demographic factors affecting the adequacy of PNC services is important for equitable access.

Objectives: To investigate the rates and determinants of inadequate PNC among all women giving birth in Manitoba, Canada.

Methods: We conducted a retrospective cohort study using province-wide mother-infant-linked administrative health databases from January 2010 to March 2022. We identified inadequate PNC using the Revised Graduated PNC Utilization Index. Annual rates were estimated, and trends were analyzed using linear regression. Multivariable multinomial logistic regression models were used to identify determinants of inadequate PNC (e.g., sociodemographics, comorbid health conditions); adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated.

Results: Among 192,274 pregnancies, 10.4%(n=19,926) received inadequate PNC , 33.9%(n=65,143) adequate, 47.2%(n=90,732) intermediate PNC, and 7.9%(n=15,275) intensive PNC. The estimated rate of inadequate PNC increased from 10.5% in 2010 to 11.52% in 2022 (p=0.036). Pregnant women living in rural (aOR=2.30, 95%Cl: 2.06-2.57) or northern rural areas (aOR=2.3, 95% Cl: 2.04-2.61) were more likely to receive inadequate PNC, as were women with lower income (aOR=1.97, 95%Cl:1.89-2.04). Older maternal age and comorbid conditions such as diabetes, maternal psychological distress, and hypertension were also associated with lower odds of inadequate PNC. Women with a parity of 2 or more were significantly more likely to experience inadequate PNC (aOR 4.31, 95%CI:4.14-4.48).

Conclusions: This study highlights significant inequities in prenatal care access in Manitoba, with socioeconomic status and area of residence representing key determinants. Addressing these disparities presents an opportunity for implementing targeted interventions to improve prenatal care and outcomes. Further research is needed to identify additional factors contributing to this inequity and assess the association between inadequate care and adverse pregnancy outcomes.