Original Research
Maternal Health / Health Services

Usage of Home-Based Maternal Health Record in Antenatal Monitoring Among Malaysian Women Attended University Kebangsaan Malaysia Medical Centre

Last reviewed: March 2026

Background

Home-based maternal health records are handheld documents retained by pregnant women that serve as a portable repository of essential antenatal, delivery, and postnatal health information. Over 160 countries worldwide utilise some form of home-based record to improve maternal, newborn, and child health outcomes. These records facilitate continuity of care across different providers and settings, empower women with knowledge about their own health status, and serve as a communication tool between healthcare providers and pregnant women.

In Malaysia, the maternal health record (Kad Kesihatan Ibu or “Pink Book”) is a standardised document provided to all pregnant women at their first antenatal visit. It contains sections for recording personal and obstetric history, results of routine antenatal investigations, blood pressure and weight measurements, foetal growth parameters, and notes from healthcare providers. Women are expected to carry this record to all antenatal appointments, during labour and delivery, and to postnatal visits.

Malaysia’s maternal health system has achieved remarkable success over several decades, with the maternal mortality ratio declining dramatically from 530 per 100,000 live births in 1957 to comparatively low levels in recent years. This achievement has been attributed in part to the strong antenatal care infrastructure, including the systematic use of maternal health records. However, the effectiveness of any record-keeping system depends ultimately on how well it is used by both healthcare providers and the women themselves.

Study Design and Methods

This study was conducted at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a major tertiary referral hospital in Kuala Lumpur. The study examined the patterns and completeness of home-based maternal health record usage among pregnant women attending the hospital’s antenatal clinic. The research employed a cross-sectional design, recruiting pregnant women who presented for antenatal care during the study period.

Data collection involved two complementary approaches: physical examination of the women’s home-based maternal health records to assess completeness of recorded information, and administration of a structured questionnaire to gather information about the women’s understanding and utilisation of the record. The questionnaire captured sociodemographic characteristics, obstetric history, knowledge about the purpose and contents of the maternal health record, frequency of record consultation at home, and perceptions about the usefulness of the record in managing their pregnancy.

Completeness of the maternal health record was assessed by checking whether key data fields had been filled in for each antenatal visit, including blood pressure measurements, weight recordings, urine test results, haemoglobin levels, foetal heart rate, fundal height, and any provider notes about complications or management plans. A scoring system was used to quantify overall record completeness.

Results

The study revealed considerable variation in how comprehensively the maternal health records were completed and utilised. While the majority of women consistently brought their records to antenatal appointments, the completeness of recorded information varied across different parameters and visits. Basic measurements such as blood pressure and weight were generally well-recorded, while other parameters showed more frequent gaps.

Women’s knowledge about the contents and purpose of their maternal health record varied with education level. Those with higher educational attainment generally demonstrated better understanding of the information contained in their records and reported more frequent consultation of the record at home between appointments. Multiparous women (those with previous pregnancies) tended to show greater familiarity with the record system, although this did not always translate into more complete recording.

The study identified several barriers to optimal record usage, including time constraints during busy clinic sessions that limited the thoroughness of record completion by providers, women’s limited health literacy affecting their ability to understand and engage with the recorded information, and occasional loss or damage to the physical record.

Malaysia’s Antenatal Care System

Understanding these findings requires appreciating the structure of Malaysia’s antenatal care system. Routine antenatal care in Malaysia is provided through a network of government primary healthcare clinics (Klinik Kesihatan) as well as private general practices and specialist clinics. The Ministry of Health’s guidelines recommend a minimum number of antenatal visits, with specific investigations and assessments scheduled at defined gestational ages.

Women with risk factors or complications identified during screening are referred to hospital-based antenatal clinics for shared care or specialist management. The home-based maternal health record plays a critical role in this shared-care model, as it carries information across settings and facilitates communication between primary and tertiary providers. When referral hospital clinicians receive a pregnant woman, the maternal health record provides immediate access to her antenatal history, investigation results, and any issues flagged by the referring provider.

The effectiveness of this system depends on consistent, complete documentation by all healthcare providers who encounter the pregnant woman, as well as the woman’s own engagement with the record. The UKMMC setting, as a tertiary centre receiving referrals from across the Klang Valley, provided an opportunity to assess record usage among a diverse population of pregnant women with varying risk profiles.

Public Health Implications and Significance

The findings have practical implications for strengthening Malaysia’s antenatal care delivery. Incomplete recording of maternal health parameters represents a missed opportunity for monitoring and early detection of complications. Strategies to improve record completeness might include redesigning record formats to be more intuitive and user-friendly, incorporating digital or electronic record systems that prompt providers to complete all fields, and enhancing health literacy programmes that help pregnant women understand and actively engage with their health records.

The observation that education level influences record engagement suggests a need for targeted communication strategies for women with lower educational attainment. Visual aids, simplified explanations in multiple languages, and community health educator support could help bridge literacy gaps and ensure that all women benefit equally from the maternal health record system.

These findings are relevant to the broader global discourse on home-based records and their role in improving maternal and child health outcomes, particularly in low- and middle-income countries where continuity of care across multiple providers is a common challenge.

Limitations

The study was conducted at a single tertiary centre in Kuala Lumpur, which receives a selected population of pregnant women, including a higher proportion of high-risk cases. Findings may not be directly generalisable to the primary care setting where the majority of routine antenatal care is delivered. The cross-sectional design captures usage patterns at a single point in time and does not track changes across the course of pregnancy. Self-reported data on record consultation behaviour may be subject to recall and social desirability biases.

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