Prenatal care in Brussels. Pilot study on health care trajectories: defining differences and influencing factors. First results.

Birth registration forms in Brussels show that some categories of mothers are at higher risk of adverse birth outcome. Although many studies conclude that adequate use of prenatal care influences birth outcome positively, hitherto little is known about the way in which prenatal care trajectories are effectuated. Knowledge on factors contributing to differences in care trajectories may help to improve prenatal care organization. Our pilot study examines individual and organizational factors influencing prenatal care trajectories according to the conceptual model of Anderson and Newman.


For the first time, prenatal care trajectories in Brussels (Belgium) were documented in a self-reporting prospective study. Women were consecutively recruited on one of their first consultations in prenatal health care settings. Intercultural workers assisted in the recruitment to include pregnant women from more vulnerable groups. A total of 122 women agreed to document each prenatal consultation in a specially designed care booklet. Bimonthly follow-up was conducted by telephone interviews.


The Adequacy of Prenatal Care Index, often used to describe prenatal care use, does not include content of care. As we collected data on both content of care and timing in pregnancy, we looked for a more advanced definition based on the Belgian guideline. Our first definition takes 3 basic medical acts into account: ultrasound, blood pressure and blood sample. The first results of this still ongoing research show that women living alone, not born in Belgium, belonging to the lowest income categories, not having a health insurance or not starting prenatal care in the first trimester of pregnancy receive less care than recommended or at a wrong timing. The same trend was observed when using a second definition for care trajectories based on care-packages received in each trimester. Preliminary, we can conclude that both individual and organizational determinants seem to influence prenatal care use trajectories.