Reducing Inequalities in Timing of Antenatal Care Initiation: A Hypothetical Intervention in the Generation R Study

Objective: To investigate inequalities in antenatal care initiation and to assess whether early pregnancy recognition may reduce these inequalities. Design: Population-based birth cohort study. Setting: Rotterdam, the Netherlands. Population A cohort of N=4196 pregnant women from Generation R. Methods: The association of individual and socioeconomic factors and gestational age at pregnancy recognition with timing of antenatal care initiation were assessed using linear regression analyses. G-methods were used to estimate the reduction of the inequalities in antenatal care initiation, if everyone would have recognized the pregnancy within 6 weeks after the first day of menstrual period. Main Outcome Measures Antenatal care initiation was derived from electronic patient files of 10 midwifery practices in Rotterdam. Results: Those who recognized their pregnancy within 6 weeks (81.7%) had their first antenatal care visit 1.26 weeks (95%CI:-1.59; -0.93) earlier than those who recognized their pregnancy after 6 weeks. All factors were significantly associated with timing of antenatal care initiation. Modeling a situation in which people would recognize their pregnancy within 6 weeks resulted in a significant reduction in the inequalities in antenatal care initiation for age, migration background, pregnancy intention, education, employment, household income, housing, and neighborhood deprivation. Conclusions: Early recognition of pregnancy would reduce the impact of socio-economic inequalities in timely initiation of prenatal care.