title: Predictors of late initiation for prenatal care in a metropolitan region in Belgium. A cohort study.
abstract: OBJECTIVE
  Timely initiation of prenatal care (PNC) in the first pregnancy trimester allows prevention, identification and treatment of risk factors. However, not all women initiate PNC timely, especially women in a deprived situation. The aim of this study was to measure the prevalence of late initiation, defined as initiation after 14 weeks of gestational age. Secondly the authors wanted to identify predictors for late PNC onset.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Pregnant women (n = 1750) were recruited in all four hospitals in Ghent (Belgium), a metropolitan region. A socio-economic deprivation ranking was measured by using a General Deprivation Index (GDI), which consists of six criteria to assess a socio-economic situation as deprived. A univariate analysis and a forward conditional multivariate logistic regression model were used analysing the association between deprivation and the likelihood to initiate PNC late.
  
  
  RESULTS
  1115 women were included of whom 6.1% (n = 68) initiated PNC late. A foreign maternal country of birth (OR 2.10; 95% CI 1.15-3.83) and a total GDI ≥3 (OR 4.40; 95% CI 2.36-8.21) were good predictors for late initiation. More specifically, the GDI criteria education (OR 4.02; 95% CI 2.00-8.08) and unemployment (OR 2.40; 95% CI 1.17-4.90) were significantly associated with higher likelihood for late initiation.
  
  
  CONCLUSIONS
  A small group of women initiates PNC late. Vulnerable groups, at risk for late initiation can be identified through assessing their deprivation status. Priority for additional support should be given to women with low educational attainment or women in uncertain employment situations.
authors.affiliation: I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium. Electronic address: maaike.fobelets@vub.ac.be.
authors.forename: M
authors.initials: M
authors.lastname: Fobelets
authors.affiliation: Department of Medical Sociology and Health Sciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Nursing and Midwifery, Nursing and Midwifery Research Group, Universitair Ziekenhuis Brussel, Brussel, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Beeckman
authors.affiliation: Department of Midwifery, University College Arteveldehogeschool Ghent, Gent, Belgium; Department of Pedagogy of the Young Child, University College Arteveldehogeschool Ghent, Gent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Hoogewys
authors.affiliation: Department of Midwifery, University College Arteveldehogeschool Ghent, Gent, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Embo
authors.affiliation: Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Buyl
authors.affiliation: I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium; School of Health, University of Central Lancashire, Preston, Lancashire, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Putman
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium; D015331:Cohort Studies; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: Delivery of health care (MeSH); Deprivation; Health services accessibility (MeSH); Initiation of care; Pregnancy (MeSH); Prenatal care (MeSH)