Examining the Benefits of Early Prenatal Care Using US Birth Records

OBJECTIVES: Prenatal care starting in the first trimester is widely accepted as a best practice for improving maternal health. However, evidence is limited on the association between early prenatal care and maternal and infant health outcomes. This study evaluated maternal and infant health outcomes among nulliparous mothers to evaluate associations between late (≥4 months) prenatal care or no prenatal care compared with early (months 1-3) prenatal care. METHODS: We used birth record data from the National Center for Health Statistics for this analysis. The study population consisted of singleton, nulliparous live births to mothers who gave birth in the United States from January 1, 2014, through December 31, 2022. RESULTS: Compared with early prenatal care, late initiation of prenatal care was associated with an increased risk of preterm birth (risk ratio [RR] = 1.21; 99% CI, 1.15-1.28), insufficient gestational weight gain (RR = 1.23; 99% CI, 1.17-1.30), and no reported breastfeeding at discharge (RR = 1.09; 99% CI, 1.06-1.13). Compared with early prenatal care, no prenatal care was associated with substantially greater risk across nearly every measured outcome, including preterm birth (RR = 2.26; 99% CI, 1.82-2.80), low birth weight (RR = 2.03; 99% CI, 1.72-2.40), neonatal intensive care unit admission (RR = 1.88; 99% CI, 1.48-2.39), abnormal conditions of the newborn (RR = 1.87; 99% CI, 1.73-2.02), and no reported breastfeeding at discharge (RR = 1.90; 99% CI, 1.53-2.35). Prenatal care timing was not significantly associated with maternal morbidity. CONCLUSION: These findings highlight that although early prenatal care results in the best outcomes, late prenatal care still has important benefits relative to no prenatal care.