title: Content and timing of antenatal care: predisposing, enabling and pregnancy-related determinants of antenatal care trajectories.
abstract: BACKGROUND
  When examining risk factors for inadequate antenatal care, the assessment of antenatal care hardly considers the content and timing of interventions during pregnancy. This study aims to provide information about the importance of predisposing, enabling and pregnancy-related determinants on the received content and timing of antenatal care.
  
  
  METHODS
  In the Brussels Metropolitan Region, 333 women were consecutively recruited at the beginning of their pregnancies. Antenatal care use was recorded prospectively. A classification system measuring the content and timing of care during pregnancy (CTP) divided the women into four categories. Ordinal regression analyses were applied to define unadjusted and adjusted odds ratios (ORs), measuring the effect of different determinants on being assigned to a higher CTP category.
  
  
  RESULTS
  A total of 10.2% of the women had an inadequate, 8.4% an intermediate, 36% a sufficient and 45.3% an appropriate antenatal care trajectory. Adjusted ORs showed a lower likelihood of being assigned to a higher CTP category for lower educated women (OR: 0.58; 95% CI 0.37-0.92), women of Maghreb origin (OR: 0.38; 95% CI 0.22-0.66) and women with a higher discontinuity of care (OR: 0.56; 95% CI 0.34-0.90).
  
  
  CONCLUSIONS
  When controlling for confounders, no enabling determinants were found that affect the content and timing of care in pregnancy. Although antenatal care is equally available to all women, predisposing and pregnancy-related factors were related to the likelihood of completing an appropriate antenatal care trajectory. Besides stimulating knowledge about the importance of antenatal care in less-educated and Maghreb women, supporting continuity of care during pregnancy might result in higher levels of received antenatal care.
authors.affiliation: Department of Medical Sociology and Health Sciences, Vrije University Brussels, Brussels, Belgium. katrien.beeckman@uzbrussel.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Beeckman
authors.forename: Fred
authors.initials: F
authors.lastname: Louckx
authors.forename: Koen
authors.initials: K
authors.lastname: Putman
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium; D003266:Continuity of Patient Care; D005260:Female; D005865:Gestational Age; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D010298:Parity; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult