Antenatal care initiation in an ethnically dense socially disadvantaged maternal cohort

Abstract

Background: Differential utilisation of antenatal care among ethnic minority mothers is a contributor to their increased risk of poor birth outcomes in developed countries. Links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood. This study investigated patterns of antenatal care initiation among an ethnically dense, socially disadvantaged maternal cohort. Methods: We conducted a retrospective analysis of routinely collected anonymous data of live singleton births in a maternity unit serving an ethnically diverse population. We applied univariate regression models to examine the association between late antenatal care initiation and various predictor variables in particular ethnicity and area deprivation. Results: Gestational week at antenatal initiation was available for 46,089 births. One fifth (20.9%) of mothers initiated antenatal care after 12 weeks of gestation including 11.9% who had their first antenatal appointment at 13 -20 weeks (moderately late) and 8.9% who had it later than 20 weeks (extremely late). Among all the factors considered, late initiation was most strongly associated with non-White British ethnicity. Black African (34.2%) and Black Caribbean (29.0%) mothers were more than twice as likely to initiate antenatal care after 12 weeks of gestation compared to White British mothers [Odds ratio (OR) = 2.69 and 2.15 respectively). The odds did not increase with increasing area deprivation except for moderately late initiation in the most deprived and second most deprived areas [unadjusted OR = 1.54 and 1.24 respectively]. Conclusions: Non-White British ethnicity was the key predictor of late antenatal care initiation in our ethnically dense socially disadvantaged maternal cohort. Impact: Programs and policies should take in to account ethnic variations in antenatal careinitiation while designing programs and policies to improve birth outcomes in ethnically dense socially disadvantaged areas. Key messages: Non-White British ethnicity was the key predictor of late antenatal care initiation. Area deprivation per se appeared to have limited association with late antenatal care initiation.