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Background: Prenatal care is a preventive public health intervention aimed at improving maternal and infant health outcomes in United States. Many women have late or no prenatal care. However, when women recognize their pregnancies early they have better birth outcomes including reduced preterm births, reduced low birth weight and reduced admission into neonatal intensive care unit. This study examined whether the “time lag” in initiating prenatal care after pregnancy recognition is associated with adverse birth outcomes.

Hypothesis: Among women who participate in prenatal care, a longer time lag between the time of pregnancy recognition and the time of initiation of prenatal care initiation are associated with adverse birth outcomes such as prematurity (gestational age below 37 weeks), LBW (birth weight below 2500 grams), admission into NICU, infant mortality (death before one year of age).

Methods: The study is a secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) multi-state data for United States from 2000-2004. The PRAMS program entails cross-sectional surveys, addressing maternal behaviors and experiences that occur before, during, and shortly after pregnancy among U.S. women of childbearing age. The study consisted of 135,623 women and the analysis involved weighting of complex survey data using STATA9.2 software. Univariate analyses and logistic regressions were used.

Results: The average time lag (difference between the time of PNC initiation and the time of pregnancy recognition) for the study is 3.2 weeks (99% CI = 3.12 - 3.21). The mean time lag is longer among women who recognized their pregnancies early (3.5 weeks, CI = 3.43 – 3.53) than women who recognized their pregnancies late (2.1 weeks, CI = 1.96 – 2.15). Despite this longer time lag, this study still shows that women who recognized their pregnancy early tend to initiate prenatal care early. After controlling for possible confounding variables including: time of pregnancy recognition, maternal age, race/ethnicity, parity, marital status, level of education, socio-economic status measured as being on other public assistance (apart from Medicaid), incidence of having multiple births (twins or more), drinking and smoking behavior during pregnancy, previous birth outcomes (premature births and LBW babies), and prepregnancy body mass index (BMI); longer timelag between time of pregnancy recognition and prenatal care initiation were associated with reduced prematurity, (OR = 0.99, p-value < 0.01), reduced LBW (OR = 0.98, p-value < 0.01) and reduced NICU admission (OR = 0.99, p-value < 0.01).

Conclusions: The time lag is longer among women with early pregnancy recognition; and this delay is not associated with poor outcomes. Further studies are needed to identify the factors associated with longer time lag after pregnancy recognition, and how these factors influence birth outcomes.