<b>Determinants and feto-maternal complications associated with inadequacy of ANC visits. </b>A multicentre cross-sectional study in northern Ghana.

Background Antenatal care (ANC) is a vital component of maternal healthcare, providing continuous support from conception to delivery. It emphasizes both maternal and foetal monitoring to identify early risk factors and offers essential education on nutrition, exercise, and birth preparedness. ANC further ensures a healthy pregnancy, safe delivery, and improved neonatal outcomes. However, limited evidence exists on the sociodemographic and obstetric characteristics of women with untimely or inadequate ANC attendance. Moreover, serious foetomaternal complications, including preeclampsia, eclampsia, intrauterine growth restriction (IUGR), maternal and neonatal mortality, obstetric haemorrhage, and NICU admissions, remain underexplored, prompting this study to evaluate the prevalence and associated complications of inadequate (<4) ANC attendance and to inform strategies for improving timely and adequate (≥8) ANC utilization. Methods This study employed a retrospective cross-sectional design and included all deliveries from January 1, 2019, to December 31, 2019. The STROBE checklist for cross-sectional studies was followed throughout. Systematic sampling was conducted among mothers who delivered in six public hospitals in the Upper East Region, which collectively account for the majority of deliveries and are therefore representative of regional outcomes. Data were collected using a closed-ended abstraction form, drawing information concurrently from antenatal, prenatal, and postnatal delivery records in the Reproductive and Child Health (RCH) Unit and the maternity wards of the six hospitals. Deliveries meeting the study criteria were included. Primary data were obtained from patient folders, and secondary data from delivery books. Statistical significance was set at p < 0.05 with a 95% confidence interval. Results Among the 1,356 participants studied, the prevalence of inadequate and adequate ANC visits was 14.0% (190/1,356) and 86.0% (1,166/1,356), respectively. Inadequate and untimely ANC attendance was significantly associated with younger maternal age (22.11% vs. 13.89%, p = 0.0080), illiteracy (47.89% vs. 13.46%, p = 0.0150), basic education (33.16% vs. 26.64%, p = 0.0150), and unemployment (44.21% vs. 35.33%, p = 0.0080). Foetomaternal complications linked to inadequate ANC attendance included preterm delivery (29.47% vs. 9.78%, p < 0.0001), NICU admissions (15.26% vs. 8.15%, p = 0.0030), low birth weight (29.47% vs. 14.41%, p < 0.0001), maternal anaemia (66.84% vs. 46.74%, p < 0.0001), low 1st-minute APGAR score (22.63% vs. 15.61%, p = 0.0200), and low 5th-minute APGAR score (12.11% vs. 7.46%, p = 0.0430). Furthermore, preterm delivery [AOR = 2.58, 95% CI (1.69–3.93), p < 0.0001] and maternal anaemia [AOR = 1.90, 95% CI (1.35–2.66), p < 0.0001] were independently associated with inadequate ANC visits. Conclusion In conclusion, this study demonstrates that adequate and timely ANC attendance is strongly associated with improved maternal and neonatal outcomes in the Upper East Region of Ghana. Conversely, inadequate and untimely ANC attendance, disproportionately affecting younger, unemployed, and less educated women, was significantly linked to preterm birth, maternal anaemia, low birth weight, neonatal intensive care unit admission, and low APGAR scores. These findings underscore the critical role of sociodemographic determinants in shaping ANC utilization and highlight the need for targeted interventions to address inequities. Strengthening ANC coverage, timeliness, and quality through education, economic empowerment, and expanded access to care is essential to reduce preventable foeto-maternal complications and advance maternal and child survival.