title: Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK.
abstract: BACKGROUND
  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 aim of this study was to identify predictors for late initiation of antenatal care within an ethnically diverse cohort in East London.
  
  
  METHODS
  Cross-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.
  
  
  RESULTS
  Late 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).
  
  
  CONCLUSIONS
  Socio-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.
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom. Jenny.Cresswell@lshtm.ac.uk
authors: Jenny A
authors: JA
authors: Cresswell
authors: Ge
authors: G
authors: Yu
authors: Bethan
authors: B
authors: Hatherall
authors: Joanne
authors: J
authors: Morris
authors: Farah
authors: F
authors: Jamal
authors: Angela
authors: A
authors: Harden
authors: Adrian
authors: A
authors: Renton
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D017691:Caribbean Region / Q000208:ethnology; D003430:Cross-Sectional Studies; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D006798:Housing; D006801:Humans; D007802:Language; D008131:London; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy / Q000208:ethnology*; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care / Q000706:statistics & numerical data*; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
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