Optimizing Antenatal Care: A Systematic Review and Meta-Analysis on How Scheduling Influences Fetal Outcomes

Introduction: Maternal and neonatal health outcomes are significantly influenced by the presence or absence of prenatal care. This meta-analysis aims to comprehensively evaluate the impact of booked and unbooked pregnancies on fetal outcomes, addressing existing gaps in the literature. Despite extensive research on this topic, no prior meta-analysis has systematically examined this association. By synthesizing data from 23 studies encompassing 34,908 patients, this study provides novel insights into the relationship between prenatal booking status and fetal health outcomes. Methods: The metaanalysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO. PubMed and Google Scholar were searched for relevant literature comparing outcomes between booked and unbooked pregnancies. Inclusion criteria encompassed primary and multigravida pregnancies, singleton and multiple gestations, and both vaginal and Cesarean deliveries. Data extraction and quality assessment were performed using established tools. Statistical analyses, including forest plot approaches and sensitivity analyses, were conducted to assess overall effect sizes and address heterogeneity. Results: A total of 23 studies were included, with a combined sample size of 34,908 patients. Significant associations were observed between booked pregnancies and reduced risks of mortality, intrauterine fetal death, stillbirth, early neonatal death, and asphyxia. Booked pregnancies also exhibited a lower incidence of neonatal sepsis. However, heterogeneity and potential publication bias were noted, highlighting the need for cautious interpretation of results. Conclusion: This meta-analysis provides robust evidence supporting the positive impact of prenatal booking on maternal and fetal health outcomes. The findings underscore the importance of timely prenatal care in reducing adverse perinatal outcomes and improving neonatal well-being. Further research is warranted to address heterogeneity and potential biases, informing clinical practice and policy interventions aimed at optimizing maternal and fetal health globally.