Declining Early Prenatal Care: CDC Data Reveals Concerning Trends

The timing of prenatal care in the United States has shifted in recent years, with a concerning decline in early engagement and a corresponding rise in later initiation, according to new data from the CDC. While overall prenatal care rates remain relatively high, the trend suggests increasing barriers to access and potential implications for maternal and infant health outcomes. Between 2021 and 2024, the proportion of women beginning prenatal care in the first trimester decreased by 4%, falling from 78.3% to 75.5%.

Shifting Patterns of Prenatal Care

This decrease in first-trimester care is coupled with a 12% increase in women initiating care during the second trimester, rising from 15.4% to 17.3%. Simultaneously, the percentage of women with late or no prenatal care—defined as beginning in the seventh month of pregnancy or later—increased by 16%, from 6.3% to 7.3%. These changes were observed across all maternal age groups and among nearly all diverse populations, signaling a widespread trend rather than a localized issue. Data from 2024 show that in Washington DC, Florida, Georgia, Hawaii, New Mexico, and Texas, more than one in ten women experienced late or no prenatal care.

These findings, published in a recent CDC Data Brief, build on earlier trends. From 2016 to 2021, first-trimester prenatal care had actually increased slightly, by 2%, while second-trimester care decreased by 8%. Late or no care remained relatively stable during that period, fluctuating between 6.2% and 6.4%. The recent reversal of these gains is prompting concern among maternal health experts.

Factors Contributing to Delayed Care

Several factors are likely contributing to these shifts, according to Kim Bruno, DC, CCN, associate director medical science liaison at Sera Prognostics. Reduced access to maternal healthcare is a major driver, as provider shortages and the growing number of maternity care deserts leave many communities without adequate OB/GYN, midwifery, or birthing facility options. Systemic barriers, such as insurance access and coverage delays, can also postpone care. Social determinants of health—including limited transportation, lack of childcare, and economic pressures—further complicate access for many pregnant individuals.

The lingering effects of the COVID-19 pandemic may also play a role, contributing to staffing shortages and appointment delays. Bruno notes that late pregnancy recognition can also delay entry into care.

Why Early Prenatal Care Matters

Early prenatal visits are crucial for identifying and managing potential health risks, including hypertension, diabetes, infections, and fetal growth restriction. Many adverse outcomes, such as preterm birth, maternal complications, and low birth weight, are closely linked to a lack of early prenatal care. When care begins late, clinicians miss critical opportunities to intervene and mitigate these risks.

The importance of early prenatal care extends beyond identifying and managing existing conditions. It also provides a platform for education and counseling on healthy behaviors during pregnancy, such as nutrition, exercise, and avoiding harmful substances. This proactive approach can significantly improve both maternal and infant well-being.

ACOG Guidance and Evolving Models of Care

Recognizing the challenges in accessing timely prenatal care, organizations like the American College of Obstetricians and Gynecologists (ACOG) are advocating for more flexible, patient-centered models of care. Updated clinical guidance from ACOG encourages tailoring visit schedules to individual risk factors, expanding telehealth options, and offering extended hours to improve accessibility.

ACOG also emphasizes the importance of screening for social drivers of health early in pregnancy to identify and address barriers to care. Strengthening partnerships between primary care and obstetric services, along with improved coordination with social and community resources, is particularly critical in areas with limited maternity care access. ACOG is actively working to transform the traditional prenatal care approach, moving towards a more individualized and responsive system.

The Public Health Response and Future Directions

Addressing the decline in early prenatal care requires a multi-faceted approach. Public health surveillance systems, like those maintained by the CDC, play a vital role in monitoring trends and identifying areas of concern. Ongoing research is needed to better understand the underlying causes of delayed care and to evaluate the effectiveness of different interventions.

Efforts to expand insurance coverage, address provider shortages, and improve access to transportation and childcare are also essential. Raising awareness among pregnant individuals about the importance of early prenatal care and providing culturally sensitive education can empower them to seek care promptly.

improving early prenatal care access and utilization will require a collaborative effort involving healthcare providers, policymakers, community organizations, and individuals. By prioritizing these efforts, we can work towards ensuring that all pregnant women have the opportunity to receive the care they necessitate for a healthy pregnancy and a healthy baby.

Michelle J.K. Osterman, MHS, and Joyce A. Martin, MPH, conducted the analysis using data from the National Vital Statistics System. Their findings are available in the NCHS Data Brief, DOI: https://dx.doi.org/10.15620/cdc/174642.

Kim Bruno, DC, CCN can be reached through Emma Neal, vice president at Earned Media, at [email protected].