Time from Pregnancy Recognition to Prenatal Care and Associated Newborn Outcomes

Objective: To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy.

Design: Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States.

Setting: Twenty-nine states.

Participants: Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births.

Methods: Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality.

Results: The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01).

Conclusion: Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.