BackgroundPublished guidelines emphasise the need for early antenatal care to promote maternal and neonatal health. Inadequate engagement with antenatal care is associated with adverse pregnancy outcomes including maternal death. The factors that influence the uptake and utilisation of maternity care services are poorly understood. We retrospectively explore a large maternity database of births in a large referral UK hospital to capture the socio-demographic factors that influence late pregnancy booking, and then prospectively compare the stress and social support status of consenting early and late-booking women.MethodsRetrospective socio-demographic and clinical outcome data on 59,487 women were collected from the maternity database record of births between 2002 and 2010 at the Jessop Wing Hospital, Sheffield UK. In a follow-on prospective survey between October 2012 and May 2013 a convenience cohort of early and late bookers for antenatal care were then studied using validated scales for fetomaternal attachment, stress and anxiety, and social support.ResultsIn our retrospective study, pregnancy during the teenage years, higher parity, non-white ethnic background, unemployment and smoking were significantly associated with late access to antenatal services and poor fetal outcomes (P < 0.001). However, late booking per se did not predict adverse fetal outcomes, when socio-demographic factors were accounted for. A high index of multiple deprivation (IMD) score remained independently associated with late booking when confounding factors such as ethnicity and employment status were controlled for in the model (P = 0.03). Our prospective data demonstrated that women who book late were more likely to be unmarried (OR: 3.571, 95 % CI: 1.464–8.196, p = 0.005), of high parity (OR: 1.759, 95 % CI: 1.154–2.684, P = 0.009), and have lower social support than early bookers (P = 0.047).ConclusionsOf the many complex sociocultural factors that influence the timing of maternal engagement with antenatal care, multiple deprivation and poor social support remain key factors. Improving access to prenatal care requires in-depth exploration of the relationship between maternal psychosocial health indices, social support mechanisms and engagement with antenatal care. Findings from these studies should inform interventions aimed at improving access to care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0753-3) contains supplementary material, which is available to authorized users.

Background Delayed access to antenatal care is linked to maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill-health, with national health data showing discrepancies in the access and utilisation of care by groups of women who differ by ethnicity, age and socioeconomic status. Objectives To map the prevalence of social deprivation and delayed access to antenatal care amongst women attending a regional referral maternity service and to correlate with fetal outcomes. Methods Retrospectively analysed data collected from 59,847 singleton births at the Jessop Wing Hospital, Sheffield, UK, between 2002 and 2010, identifying maternal demographic features and neonatal outcomes. We plotted the Index of Multiple Deprivation (IMD) scores of women against the distribution of delayed access to antenatal care. Results The geographic distribution of high deprivation scores and first pregnancy care attendance after 20 weeks gestation matched closely. High IMD scores increased the risk of being a late booker (OR: 1.092, 95% CI: 1.01–1.18, p = 0.031) and being of minority ethnic extraction (OR: 5.6, 95% CI: 5.2–5.9, p < 0.001), and significantly predicted low birth weight (OR: 1.66, 95% CI: 1.31–2.12, p < 0.001), premature delivery (OR:1.34, 95% CI: 1.06–1.70, p = 0.017) and stillbirth (OR: 2.25, 95% CI: 1.68–3.01, p < 0.001). When sociodemographic variables were adjusted for, late booking did not independently predict adverse maternal or fetal outcomes. Conclusions Disparities remain for women from certain backgrounds. Geographic mapping of high deprivation scores can direct research and health delivery strategies seeking to promote better access to pregnancy care and mitigate the resulting adverse fetal outcomes.

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