Correlates of Early Prenatal Care Access among U.S. Women: Data from the Pregnancy Risk Assessment Monitoring System (PRAMS)

Abstract

Objectives Early first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change. Methods The study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions—when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care. Results On average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card. Conclusions for Practice This study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted. What is already known on this subject? Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit. What this study adds? Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.

Primeiros 2.200 dias de vida como janela de oportunidade de atuação multidisciplinar relativa à origem desenvolvimentista de saúde e doença: posicionamento da Associação Brasileira de Nutrologia

“…Há questões relacionadas a acesso e qualidade desse cuidado, mas, de maneira geral, a mulher grávida tem a predisposição de procurar ajuda médica e está disposta a realizar medidas para melhorar sua qualidade de saúde. Dessa forma, a identificação de vulnerabilidades e estratificação de riscos, além da realização de intervenções preventivas e terapêuticas consagradas, são fundamentais [26][27][28].…”

The Early Care Model for Initiation of Perinatal Care: “I Actually Felt Listened To”

“…Financial concerns, lack of insurance, and various social needs 13 may also delay access to care 1,14,15 . In a study of pregnant low‐income people, 66% of the uninsured participants did not attend any first trimester appointments 15 .…”

“…Initiating prenatal care in the first trimester better equips health care providers to identify issues which may contribute to adverse outcomes and provide timely treatment, counseling, and referrals. Despite the demonstrable effectiveness of early access to perinatal care, significant barriers are associated with care initiation 1 …”

“…On a global level, access to timely 1 and respectful perinatal care has been shown to reduce perinatal mortality 9 and fetal harm 10 . In the United States, long wait times for perinatal care and delayed scheduling are common.…”

“…12 Financial concerns, lack of insurance, and various social needs 13 may also delay access to care. 1,14,15 In a study of pregnant low-income people, 66% of the uninsured participants did not attend any first trimester appointments. 15 In contrast, only 9% of participants who accessed insurance in the first trimester did not attend first trimester visits.…”