Enthoven Clair A, Labrecque Jeremy A, El Marroun Hanan, Lucassen Nicole, Gootjes Dionne V, van Vliet Eefje, Bijma Hilmar H, Jansen Pauline W
Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, the Netherlands.
Paediatr Perinat Epidemiol. 2025 Aug;39(6):502-511. doi: 10.1111/ppe.70020. Epub 2025 Apr 6.
Much research has focused on identifying predictors of late antenatal care initiation. Many of these predictors (e.g., young age, migration background, socioeconomic position) are impossible to modify, illustrating the need to explore other interventions.
This study aims to investigate inequalities in antenatal care initiation and assess whether early pregnancy recognition may reduce these inequalities.
Data from Generation R were used (N = 4196), a population-based birth cohort study in Rotterdam, The Netherlands. The association of gestational age at pregnancy recognition with the timing of antenatal care initiation and associations of individual and socioeconomic factors with the timing of antenatal care initiation were assessed using linear regression analyses. G-methods were used to estimate the reduction of the inequalities in antenatal care initiation if everyone would have recognised the pregnancy within 6 weeks.
Participants who recognised their pregnancy within 6 weeks (81.7%) had their first antenatal care visit 1.3 weeks (95% confidence interval [CI] -1.6, -0.9) earlier than those who recognised their pregnancy after 6 weeks. All individual and socioeconomic factors were associated with the timing of antenatal care initiation. Modelling a scenario where pregnancy recognition occurred within 6 weeks reduced inequalities in antenatal care initiation timing across several groups: age < 20 versus 30-35 (-0.4 weeks, 95% CI -0.7, -0.2), first-generation migrants versus no migration (-0.1 weeks, 95% CI -0.2, 0.0), unplanned/ambivalent versus planned pregnancies (-0.4 weeks, 95% CI -0.6, -0.2), lower versus higher educational attainment (-0.1 weeks, 95% CI -0.2, 0.0), unemployed versus employed (-0.1 weeks, 95% CI -0.2, 0.0), low versus high household income (-0.1 weeks, 95% CI -0.3, 0.0), renters versus homeowners (-0.1 weeks, 95% CI -0.2, 0.0), and high versus low neighbourhood deprivation (-0.1 weeks, 95% CI -0.2, -0.1).
Early recognition of pregnancy may help reduce the impact of socio-economic inequalities in the timely initiation of antenatal care.
许多研究都聚焦于确定晚期产前护理开始的预测因素。其中许多预测因素（例如，年轻、移民背景、社会经济地位）无法改变，这表明需要探索其他干预措施。
本研究旨在调查产前护理开始方面的不平等现象，并评估早期妊娠识别是否可以减少这些不平等现象。
使用了来自荷兰鹿特丹基于人群的出生队列研究“R世代”的数据（N = 4196）。使用线性回归分析评估妊娠识别时的孕周与产前护理开始时间的关联，以及个体和社会经济因素与产前护理开始时间的关联。使用G方法估计如果每个人都在6周内识别出妊娠，产前护理开始不平等现象的减少情况。
在6周内识别出妊娠的参与者（81.7%）比在6周后识别出妊娠的参与者首次产前护理就诊时间早1.3周（95%置信区间[CI] -1.6，-0.9）。所有个体和社会经济因素都与产前护理开始时间有关。模拟妊娠在6周内被识别的情况，减少了几个群体在产前护理开始时间上的不平等：年龄<20岁与30 - 35岁（-0.4周，95% CI -0.7，-0.2）、第一代移民与非移民（-0.1周，95% CI -0.2，0.0）、意外/矛盾妊娠与计划妊娠（-0.4周，95% CI -0.6，-0.2）、低教育程度与高教育程度（-0.1周，95% CI -0.2，0.0）、失业与就业（-0.1周，95% CI -0.2，0.0）、低家庭收入与高家庭收入（-0.1周，95% CI -0.3，0.0）、租房者与房主（-0.1周，95% CI -0.2，0.0）以及高邻里贫困与低邻里贫困（-0.1周，95% CI -0.2，-0.1）。
早期识别妊娠可能有助于减少社会经济不平等对及时开始产前护理的影响。
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