title: Timing of prenatal care initiation and risk of congenital malformations.
abstract: BACKGROUND
  Although previous studies provide some evidence that timing of prenatal care initiation is associated with risks of congenital malformation, the issue has not previously been examined in depth. This study uses data from a large population-based registry to explore the association of timing of prenatal care initiation with risks of selected congenital malformation phenotypes.
  
  
  METHODS
  Data on cases were grouped according to four-digit malformation codes of the International Classification of Diseases, Ninth Revision (ICD-9). A randomly selected group of 10,000 nonmalformed deliveries served as the comparison group. Information on month of initiation of prenatal care (categorized as during months 1-3 of gestation, months 4-7, or after month 7) and other maternal characteristics were derived from vital statistics data.
  
  
  RESULTS
  Among the 176 four-digit ICD groupings, 67 had an adjusted odds ratio for at least one of the two prenatal care categories that was either < or = 0.67 or > or = 1.50. Later prenatal care initiation was associated with risk > or = 1.50 for most groups. Later care was associated with risk < or = 0.67 for only two groups, and the effects were imprecise. Statistical interaction between parity and prenatal care was indicated for 13 groups (P < 0.10). Risks among women with no previous pregnancy tended to increase with later prenatal care initiation; risks among parous women tended to be somewhat weaker. In general, associations applied to a wide range of malformation groups.
  
  
  CONCLUSIONS
  This is the first large-scale study of the association of timing of prenatal care initiation and congenital malformation risks. Further defining the phenomena that surround prenatal care as a marker may help clarify the etiologies of a variety of malformations.
authors.affiliation: March of Dimes Birth Defect Foundation, California Birth Defects Monitoring Program, Oakland, California 94606, USA. sca@cbdmp.org
authors.forename: Suzan L
authors.initials: SL
authors.lastname: Carmichael
authors.forename: Gary M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Verne
authors.initials: V
authors.lastname: Nelson
mesh_terms: D000013:Congenital Abnormalities / Q000196:embryology / Q000628:therapy*; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D013997:Time Factors