Predictors of Adherence to an Online Prenatal Education Course for Pregnant Women: A Retrospective Cohort Study

Introduction Prenatal education courses for pregnant women appear to be an effective strategy to facilitate maternal adaptation, especially during labor. Consequently, maintaining high adherence rates to these courses is crucial for improving health outcomes in pregnant women and enhancing their experience during the transition through this stage. However, in Latin America, low adherence to in-person prenatal education courses has consistently been reported. On the other hand, adherence to online courses and the factors associated with permanence have been poorly studied in this context. Objective This study aimed to identify factors that predict pregnant women's adherence to an online prenatal education course. Methods This retrospective cohort study included pregnant women who voluntarily enrolled in an open-access online prenatal education course between 2020 and 2025. The main outcome was adherence to the course. Sociodemographic variables and pregnancy-related characteristics were considered potential predictors. Population characteristics were summarized using descriptive statistics. A logistic regression model was constructed to identify independent predictors of adherence. Results A total of 1,624 pregnant women were included, 43.59% completed the course. Enrolling in the course between 2023 and 2025 (OR = 1.95, 95% CI = 1.57 to 2.41), having a planned pregnancy (OR = 1.81, 95% CI = 1.34 to 2.47), having an educational level higher than primary school (OR = 1.58, 95% CI = 1.21 to 2.06) and attending more prenatal visits (OR = 1.05, 95% CI = 1.00 to 1.09) were independent predictors of course completion. Conclusion Fewer than half of the enrolled pregnant women completed the online prenatal education course. Strategies need to be implemented to improve adherence, especially among pregnant women who report unplanned pregnancies, lower educational levels, and fewer prenatal visits.