Effect of completing eight or more antenatal care contacts on adverse pregnancy outcomes in a district hospital in Ghana: A propensity score–matched and doubly robust analysis

Introduction: Evidence from low- and middle-income countries (LMICs), especially using robust causal inference techniques to estimate the association between ≥8 antenatal care (ANC) contacts and adverse pregnancy outcomes, remains limited. This study examines the association between completing eight or more ANC contacts and adverse pregnancy outcomes, specifically low birth weight (LBW) and preterm birth (PTB). Methods: A cross-sectional study was conducted using retrospective delivery data at Juaben Government Hospital, Ghana. LBW and PTB were compared between women who made ≥8 ANC contacts and those who did not. Propensity score matching (1:1), inverse probability of treatment weighting, and doubly robust estimates were employed to address confounding and estimate the association between completing ≥8 ANC contacts and LBW and PTB. Results: At baseline, the sample included 2156 women, of whom over half (51.3%) had ≥8 ANC contacts before delivery. After matching, women in both groups had similar characteristics. After matching on covariates, women with ≥8 ANC contacts had approximately 31.0% (ATT: 0.69; 95%CI: 0.53-0.90) and 54.0% (ATT: 0.46; 95%CI: 0.37-0.57) lower risks of delivering a LBW infant and a PTB, respectively. Inverse probability of treatment weighting and doubly robust estimates yielded comparable estimates for both outcomes. In a secondary analysis of ≥4 ANC contacts, the magnitude of the association was weaker than that observed in the ≥8 ANC model. Conclusion: This study demonstrated that completing ≥8 ANC contacts was consistently associated with lower odds of LBW and PTB among this cohort of pregnant women. This finding adds to the limited empirical evidence from LMICs on the implementation of the WHO eight-contact ANC model, suggesting that higher ANC contacts in a similar resource-constrained setting may be associated with improved maternal and infant outcomes.