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

Background: Much research has focused on identifying predictors of late antenatal care initiation. Many of these predictors (e.g., young age, migration background, socioeconomic position) are impossible to modify, illustrating the need to explore other interventions.

Objectives: This study aims to investigate inequalities in antenatal care initiation and assess whether early pregnancy recognition may reduce these inequalities.

Methods: Data from Generation R were used (N = 4196), a population-based birth cohort study in Rotterdam, The Netherlands. The association of gestational age at pregnancy recognition with the timing of antenatal care initiation and associations of individual and socioeconomic factors with the 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 recognised the pregnancy within 6 weeks.

Results: Participants who recognised their pregnancy within 6 weeks (81.7%) had their first antenatal care visit 1.3 weeks (95% confidence interval [CI] -1.6, -0.9) earlier than those who recognised their pregnancy after 6 weeks. All individual and socioeconomic factors were associated with the timing of antenatal care initiation. Modelling a scenario where pregnancy recognition occurred within 6 weeks reduced inequalities in antenatal care initiation timing across several groups: age < 20 versus 30-35 (-0.4 weeks, 95% CI -0.7, -0.2), first-generation migrants versus no migration (-0.1 weeks, 95% CI -0.2, 0.0), unplanned/ambivalent versus planned pregnancies (-0.4 weeks, 95% CI -0.6, -0.2), lower versus higher educational attainment (-0.1 weeks, 95% CI -0.2, 0.0), unemployed versus employed (-0.1 weeks, 95% CI -0.2, 0.0), low versus high household income (-0.1 weeks, 95% CI -0.3, 0.0), renters versus homeowners (-0.1 weeks, 95% CI -0.2, 0.0), and high versus low neighbourhood deprivation (-0.1 weeks, 95% CI -0.2, -0.1).

Conclusions: Early recognition of pregnancy may help reduce the impact of socio-economic inequalities in the timely initiation of antenatal care.