Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal cohort

Abstract

Background Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment >12 weeks gestation) and neonatal outcomes of preterm birth (<37 weeks gestation) and low birth weight (<2500 g) in an ethnically diverse socially disadvantaged maternal cohort. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 - March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight. Results Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at ≤ 12 weeks, 12% at 13-20 weeks, and 8.8% at > 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at ≤ 12 weeks, those booking at > 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (<28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (<1500g). Conclusions Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers. Key messages

First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors

“…However, it was lower than that of a study conducted in 54 low- and middle-income countries, with 69.1% in Central and Southern Asia, 63.5% in Eastern and Southeast Asia, 68.1% in Latin America, and the Caribbean and 54.6% in Northern America and Western Europe [ 123 ]. It was also lower than figures from other studies conducted in South Asia (59.5%) [ 124 ], India (69.3%) [ 125 ], Bangladesh (43.0%) [ 126 ], the United Kingdom (79.2%) [ 127 ], Saudi Arabia (75%) [ 126 ], Vietnam (75.2%) [ 128 ] and Malaysia (71.8%) [ 129 ]. This lower percentage may be attributed to sociodemographic variables or ineffective or inadequate strategies carried out in Africa by the relevant authorities.…”

“…However, research conducted in low-income areas of southern Asia [ 124 ] and sub-Saharan Africa(SSA) [ 22 ] found that first-trimester ANC contact was linked with a maternal age of 25 years and above. Higher parity was also associated with first-trimester ANC contact, according to research from southern Asia [ 124 ] and the UK [ 127 ]. This disparity might be the result of sociocultural variations.…”