Determinants of the number of antenatal visits in the Brussels metropolitan region.

AIMS Antenatal care is generally considered to be effective for the health of both mother and baby. Antenatal care not only affects pregnancy clinically, it also has a psychological effect preparing women for childbirth and motherhood. Although guidelines on antenatal care differ between countries, it is overall accepted that inadequate care leads to worse pregnancy outcome. Because consensus about the optimal number of antenatal visits is lacking, this study focuses on providing insights in the dynamics of the number of antenatal visits women receive. Independent effects of predisposing, enabling and pregnancy related determinants on the number of antenatal visits are examined.
METHODS Women were recruited in 9 clinical centers in the Brussels Metropolitan area. Antenatal care use was measured prospectively through a structured diary and bimonthly follow-up. A Poisson regression model was applied to measure the independent effect of predisposing, enabling and pregnancy related determinants on the number of antenatal visits.
RESULTS Data on antenatal care trajectories in 333 women were collected. The multivariate analyses showed that women with a Maghreb or Turkish origin had 14% fewer visits compared to European (EU15) women. Higher educated women had 20% more visits compared to low educated women. When controlling for all other factors one enabling determinant was related to the number of antenatal visits. Women with a high income had 14% more antenatal visits compared to women with a low income. Next to predisposing and enabling characteristics, pregnancy related factors were associated with the number of antenatal visits. Fewer antenatal visits were observed in multiparae (14%), women initiating care after 14 weeks of gestation (32%), women without medical risks during the pregnancy (12%) and in women with a continuity of care index of 50% or more (12%). More visits were observed when delivering after week 37 (20% increase).
CONCLUSIONS Especially predisposing factors have to be considered when antenatal care programs are evaluated in a metropolitan area. Variations in the number of antenatal visits show that social vulnerable women are more at risk of having fewer visits. Health care providers should pay attention to non-European (EU15) women, women with low educational level and women with low income. Future research will be needed to ascertain that the dynamics in variation of received prenatal care remain the same when examining determinants of initiation of prenatal care and content of received care.