Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK

Jenny A Cresswell,Farah Jamal,Adrian Renton,Ge Yu,Bethan Hatherall,Angela Harden,Joanne Morris

doi:10.1186/1471-2393-13-103

Abstract

BackgroundIn the UK, women are recommended to engage with maternity services and establish a plan of care prior to the 12th completed week of pregnancy. The aim of this study was to identify predictors for late initiation of antenatal care within an ethnically diverse cohort in East London.MethodsCross-sectional analysis of routinely collected electronic patient record data from Newham University Hospital NHS Trust (NUHT). All women who attended their antenatal booking appointment within NUHT between 1st January 2008 and 24th January 2011 were included in this study. The main outcome measure was late antenatal booking, defined as attendance at the antenatal booking appointment after 12 weeks (+6 days) gestation. Data were analysed using multivariable logistic regression with robust standard errors.ResultsLate initiation of antenatal care was independently associated with non-British (White) ethnicity, inability to speak English, and non-UK maternal birthplace in the multivariable model. However, among those women who both spoke English and were born in the UK, the only ethnic group at increased risk of late booking were women who identified as African/Caribbean (aOR: 1.40: 95% CI: 1.11, 1.76) relative to British (White). Other predictors identified include maternal age younger than 20 years (aOR: 1.32; 95% CI: 1.13-1.54), high parity (aOR: 2.09; 95% CI: 1.77-2.46) and living in temporary accommodation (aOR: 1.71; 95% CI: 1.35-2.16).ConclusionsSocio-cultural factors in addition to poor English ability or assimilation may play an important role in determining early initiation of antenatal care. Future research should focus on effective interventions to encourage and enable these minority groups to engage with the maternity services.

Highlights

In the UK, women are recommended to engage with maternity services and establish a plan of care prior to the 12th completed week of pregnancy
The booking appointment is the time at which a detailed history is taken, usually by a midwife, and represents the first opportunity to check a woman’s ‘risk status’; women should be screened for risk factors for gestational diabetes and pre-eclampsia at the booking appointment so that an appropriate monitoring and care plan can be implemented in good time where these are identified [3]
We had a particular interest in maternal ethnicity as a predictor of late antenatal booking; in this paper we investigate the associations between ethnicity and timing of access to antenatal care in greater detail than has been conducted previously

Summary

Introduction

In the UK, women are recommended to engage with maternity services and establish a plan of care prior to the 12th completed week of pregnancy. Late initiation of antenatal care may preclude the offer of an early ultrasound scan for accurate gestational age assessment. Nutritional supplements, such as folic acid, need to be taken very early in pregnancy in order to be effective; and women should be given advice regarding appropriate diet and exercise, the. Screening for Trisomy 21 (Down’s syndrome) should take place between 10–20 weeks gestation, ideally prior to 13 weeks +6 days gestation [5] It is of particular concern if a woman books later than 20 weeks gestation, as she may miss the window for the detailed fetal anomaly ultrasound scan

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