Objective To investigate inequalities in antenatal care initiation and to assess whether early pregnancy recognition may reduce these inequalities. Design Population-based birth cohort study. Setting Rotterdam, the Netherlands. Population A cohort of N=4196 pregnant women from Generation R. Methods The association of individual and socioeconomic factors and gestational age at pregnancy recognition with timing of antenatal care initiation were assessed using linear regression analyses. G-methods were used to estimate the reduction of the inequalities in antenatal care initiation, if everyone would have recognized the pregnancy within 6 weeks after the first day of menstrual period. Main Outcome Measures Antenatal care initiation was derived from electronic patient files of 10 midwifery practices in Rotterdam. Results Those who recognized their pregnancy within 6 weeks (81.7%) had their first antenatal care visit 1.26 weeks (95%CI:-1.59; -0.93) earlier than those who recognized their pregnancy after 6 weeks. All factors were significantly associated with timing of antenatal care initiation. Modeling a situation in which people would recognize their pregnancy within 6 weeks resulted in a significant reduction in the inequalities in antenatal care initiation for age, migration background, pregnancy intention, education, employment, household income, housing, and neighborhood deprivation. Conclusions Early recognition of pregnancy would reduce the impact of socio-economic inequalities in timely initiation of prenatal care.

Objective To investigate the association between the maternal lipid profile in early pregnancy and embryonic growth. Design Prospective population-based cohort study. Setting Rotterdam, the Netherlands. Population We included 1474 women from the Generation R(otterdam) Study. Methods The maternal lipid profile was defined as total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), remnant cholesterol, non-high-density (non-HDL-c) lipoprotein cholesterol concentrations and the triglycerides/high-density lipoprotein (TG/HDL-c) ratio. Additionally, maternal glucose concentrations were assessed. Associations were studied with linear regression models, adjusted for confounding factors: maternal age, pre-pregnancy BMI, parity, educational level, ethnicity, smoking and folic acid supplement use Main Outcome Measures Crown-rump length (CRL). Results Triglycerides and remnant cholesterol concentrations are positively associated with embryonic growth (fully adjusted models, 0.17 SDS: 95% CI 0.03 ; 0.30, and 0.17 SDS: 95% CI 0.04 ; 0.31, respectively). These associations were not present in women with normal weight (triglycerides and remnant cholesterol: fully adjusted model, 0.44 SDS: 95% CI 0.15 ; 0.72). Associations between maternal lipid concentrations and embryonic growth were not attenuated after adjustment for glucose concentrations. Total cholesterol, HDL-c, LDL-c, non-HDL-c concentrations and the TG/HDL-c ratio were not associated with embryonic growth. Conclusions Higher triglycerides and remnant cholesterol concentrations in early pregnancy are associated with increased embryonic growth, most notably in overweight women. Keywords Pregnancy, Cholesterol, Low-density lipoprotein (LDL-c), High-density lipoprotein (HDL-c), Triglycerides, Intrauterine development, Fetal growth, Early pregnancy Tweetable abstract The maternal lipid profile in pregnancy is associated with embryonic growth.