UK and Ireland guidelines state that all pregnant women should have their first antenatal care appointment by 13 weeks of pregnancy. This study presents the results of an analysis looking at the association between maternal ethnicity and late booking of antenatal care among women living with HIV in the UK and Ireland.
The authors analysed data from the National Study of HIV in Pregnancy and Childhood (NSHPC). They included all pregnancies in women who were diagnosed with HIV before delivery and had an estimated delivery date between 1 January 2008 and 31 December 2009. Late booking was defined as antenatal booking at 13 weeks or later. The baseline reference group for all analyses comprised women of ‘white’ ethnicity. There were 2721 eligible reported pregnancies; 63% (1709) had data available on antenatal care booking date. In just over 50% of pregnancies (871/1709), the antenatal booking date was late ≥ 13 weeks of pregnancy. Women diagnosed with HIV during the current pregnancy were more likely to present for antenatal care late than those previously diagnosed (59.1% vs. 47.5%, p < 0.001).
Where women knew their HIV status prior to becoming pregnant, the risk of late booking was higher for those of African ethnicity (AOR 1.80; 95% confidence interval (CI) 1.14, 2.82; p = 0.011). In women diagnosed with HIV during pregnancy, the risk of late booking was also higher for women of African ethnicity (AOR 2.98: 95% CI 1.45, 6.11; p = 0.003) and for women of other black ethnicity (AOR 3.74: 95% CI 1.28, 10.94; p = 0.016). Overall, women of African or other black ethnicity were more likely to book late for antenatal care compared with white women, regardless of when they received a HIV+ diagnosis. The authors highlight concerns that late antenatal care may have an adverse effect on maternal and infant outcomes, including vertical transmission of HIV.