Early prenatal care, considered best for moms and babies, is on the decline in the US

Early prenatal care improves the chances of having a healthy pregnancy and baby. But a new federal report shows that this phenomenon is in decline.

In the United States, the share of births to women who started prenatal care in the first trimester increased from 78.3% in 2021 to 75.5% in 2024, according to data released Thursday by the Centers for Disease Control and Prevention.

At the same time, starting care later in pregnancy or receiving no care at all is increasing. Prenatal care starting in the second trimester increased from 15.4% to 17.3%, and starting care in the third trimester or not receiving care increased from 6.3% to 7.3%.

“We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an obstetrician-gynecologist at Duke University in North Carolina. When patients delay medical care during pregnancy, “we have missed that window to optimize fetal and maternal care.”

While the trend identified in the report applied to nearly all racial and ethnic groups, the decline in early prenatal care was higher for moms from minority groups. For example, first trimester care increased from 69.7% in 2021 to 65.1% in 2024 for Black mothers. Arriving late or not receiving prenatal care increases the risk of maternal mortality, which is much higher among black mothers.

Michelle Osterman, lead author of the report, said the overall findings represent a shift. Between 2016 and 2021, the timing of U.S. women’s initiation of prenatal care improved.

According to doctors, the earlier prenatal visits begin, the earlier problems can be detected. Visits give doctors an opportunity to share health advice and may include blood pressure checks, screenings, blood tests, physical exams and ultrasounds.

The report does not provide reasons for starting antenatal care later. But the proliferation of maternity care deserts across the country is a growing concern, said Dr. Grace Ferguson, an obstetrician-gynecologist in Pittsburgh.

Many hospitals have closed labor and delivery units “and the prenatal care providers who work in those hospitals have probably moved as well,” said Ferguson, who was not involved in the report.

A 2024 March of Dimes report found that more than 35% of U.S. counties are maternity care deserts, meaning there are no birth centers or obstetrics providers. Women living in these areas receive less prenatal care, according to the report.

Ferguson, who performs abortions as part of her OB-GYN care, said post-Roe v. Wade could play a role because some obstetricians choose not to practice in states with more restrictive laws.

Alfonso, who was not involved in the CDC report, said he also suspected that access problems for patients were delaying prenatal care, particularly in rural areas. Patients may have to travel further to appointments and have difficulty finding a practice that accepts their insurance, especially if they have Medicaid.

Doctors fear the situation will get worse.

“If this trend continues,” Alfonso said, “I worry about what that would mean in terms of morbidity and mortality for our mothers.”

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