National Analysis of Risk Assessment Content in Prenatal Records Across Canada Q4 Natalie V. Scime, Rose M. Swansburg, Seija K. Kromm, Amy Metcalfe, Debbie Leitch, and Katie H. Chaput ABSTRACT Each Canadian province/territory has a distinct prenatal record form to guide maternity health care. Because there is no national oversight of these forms, little is known about how they compare regarding content on risk assessment for adverse perinatal outcomes. We cataloged and compared the risk factors that are captured on prenatal record forms across Canada. Nine out of 12 records included risk sections, with an average of 35 risk items. We identified 100 prenatal risk factors and categorized them as medical (74 Q1 %), lifestyle (11%), psychosocial (11%), or personal (5%). Where present, clinical definitions for risk factors often varied. The substantial differences in risk assessment content in the prenatal record forms may contribute to differences in health care quality among provinces. The development of standardized national guidelines for prenatal risk assessment may be a valuable goal. JOGNN, -, -–-; 2019. https://doi.org/10.1016/j.jogn.2019.07.003 Accepted July 2019 P renatal care is available universally in Can- ada and is essential to optimize maternal and fetal/neonatal health outcomes. Traditionally, prenatal care follows a pattern of fewer visits early in pregnancy that begin at 6 to 12 weeks gesta- tion; more visits occur into the third trimester. This paradigm of care was challenged by Nicolaides (2011), who noted that scientific advances have enabled clinicians to thoroughly assess patient- specific risk for adverse perinatal outcomes in the first trimester. He posited that an inverted pattern of care should occur, whereby visits are more frequent in early pregnancy and subse- quent visits are based on level of risk to facilitate individualized prenatal care. The cornerstone of Nicolaides’s proposition is to include a compre- hensive risk assessment early in pregnancy, the results of which can frame appropriate care and monitoring of a woman and her fetus. Through estimation of the likelihood of maternal and peri- natal morbidity/mortality, use of early risk assessment can shift the delivery of prenatal care from a series of routine prenatal visits to tailored visits and interventions depending on the woman (Nicolaides, 2011). Risk assessment can also be used to ensure proper triaging of patients so they can receive perinatal care from specialized providers in appropriately resourced facilities (Van Otterloo & Connelly, 2018). Evidence indicates that medical and nonmedical factors should be considered as part of a comprehensive prenatal risk assessment. For example, known risk factors for preterm birth include medical factors (e.g., preexisting medical disorders, previous preterm birth, and intrauter- ine infection) and nonmedical factors (e.g., advanced maternal age, high body mass index, prenatal depression, and low socioeconomic status; Frey & Klebanoff, 2016). Medical and nonmedical prenatal risk factors have also been shown to influence postpartum and early child- hood outcomes such as suboptimal breastfeed- ing (Kehler, Chaput, & Tough, 2009) and neurodevelopmental disorders (Gardener, Spiegelman, & Buka, 2009). There is valuable potential to address perinatal origins of maternal and child health and disease if this knowledge is translated into maternity care practices. A common vehicle to implement knowledge per- taining to health and care during pregnancy is the prenatal record (Semenic et al., 2015). As a clinical tool, the prenatal record guides health The authors report no con- flict of interest or relevant financial relationships. Correspondence Natalie V. Scime, MSc, University of Calgary, Owerko Centre in the Child Development Centre, 2500 University Dr. NW, Calgary, Alberta, Canada. natalie.scime@ucalgary.ca Keywords content analysis medical records pregnancy prenatal care risk assessment Natalie V. Scime, MSc, is a PhD candidate in the Department of Community Health Sciences, University of Calgary, and a practice consultant, Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada. Rose M. Swansburg, MBT, is a research associate in the Departments of Psychiatry and Paediatrics, University of Calgary, Calgary, Alberta, Canada. (Continued) ª 2019 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved. http://jognn.org 1 P RINCIPLES &P RACTICE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 FLA 5.6.0 DTD  JOGN460_proof  30 July 2019  8:17 pm  ce