Peer-reviewed article

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

Puthussery S, Tseng P, Sharma E, Harden A, Leah L · 1 Oct 2022

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study examined whether mothers in ethnically diverse, socially disadvantaged areas who started antenatal care after 12 weeks of pregnancy had worse outcomes for their babies. Using data from over 46,000 births at a UK hospital between 2007 and 2016, researchers found that late antenatal care initiation was strongly associated with preterm birth and low birth weight. Mothers who booked after 20 weeks of pregnancy were more than 4 times as likely to have extremely premature babies and over 3 times as likely to have babies with extremely low birth weight.

Key points

34.8% of births were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds
79.2% of mothers had their first antenatal appointment at 12 weeks or earlier, while 8.8% booked after 20 weeks
Mothers booking after 20 weeks were 4.08 times more likely to have an extremely preterm baby (<28 weeks)
Mothers booking after 20 weeks were 3.12 times more likely to have a baby with extremely low birth weight (<1500g)
The study calls for targeted intervention programmes to support early antenatal care initiation in ethnically diverse socially disadvantaged areas

Limitations

This is a retrospective cross-sectional study using routinely collected data, which cannot establish causation, only association. The study does not explore the underlying reasons for late booking or other confounding factors that might explain the associations observed.

Abstract

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 Mothers who start antenatal care late are more likely to have a preterm and/or low birth weight baby in ethnically diverse socially disadvantaged areas. There is a need for targeted programmes and services to support mothers in ethnically diverse socially disadvantaged areas to start antenatal care on time.

Findings the Hub has extracted

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Survival

Problem

Late antenatal care initiation in ethnically diverse, socially disadvantaged populations leading to adverse neonatal outcomes

Intervention: Early antenatal care initiation (first appointment at ≤12 weeks gestation)
Population: Mothers in an ethnically diverse, socially disadvantaged UK maternity unit (46,307 singleton births); 34.8% from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds

Key finding

Mothers booking at >20 weeks were 4.08 times more likely to have extremely preterm babies (<28 weeks) compared to those booking at ≤12 weeks (95% CI: 3.29-5.07)

Practitioner