An unwanted pregnancy and language proficiency level are associated with first antenatal visit after the first trimester: Results from a prospective cohort study.

Objective: To study the association between the reasons for a ‘late’ first antenatal visit and the influence of several maternal determinants and practical limitations on the timing of the first antenatal visit. Design: A prospective cohort study. Setting: Southwest region of The Netherlands, mainly characterised by large urban and suburban areas. Participants: Women receiving information and counselling about prenatal screening between April 2010 and December 2010 were included (n = 9,268). Measurements and findings: Timing of first antenatal visit, categorised as: ‘in time’ (<12+0 weeks of gestation), ‘late’ (≥12–23+6 weeks of gestation) and ‘very late’ (≥24 weeks of gestation). An unplanned or unwanted pregnancy was the most frequently reported reason for delay of the first antenatal visit (30.7%) especially in Surinamese women (79%), and women younger than 20 years (63%) or older than 40 years (50.0%). Compared to women who timed their first antenatal visit ‘in time’, women with a delay in their first visit were more often younger than 20 or older than 40 years of age, high order multiparous (P ≥3), with a previous miscarriage, and had an absent Dutch language proficiency level. The latter showed the strongest association with a ‘very late’ first antenatal visit (OR 4.96, 95%CI 2.45–10.05). 

Key conclusions: Language proficiency level was highly associated with a delay in the timing of the first antenatal visit. When women timed their first antenatal visit late, having an unplanned or unwanted pregnancy was the most frequently reported reason for this delay. Implications for practice: Findings from this study can be used to inform and develop interventions to improve timely antenatal care use.