Attitudes Toward Pregnancy and Their Impact on Timing of Prenatal Care Initiation after Prior Spontaneous Preterm Delivery: A Qualitative Descriptive Study.

Introduction: Timely presentation to prenatal care (PNC) is especially important for patients with a history of spontaneous preterm birth (sPTB). Our objective was to identify factors that pregnant individuals with prior sPTB perceived affected the timing of initiating PNC. Materials and Methods: We conducted in-depth interviews (IDIs) with non-Hispanic (NH) Black or NH White pregnant individuals who had a prior sPTB and presented early (<20 weeks gestation) or late (≥20 weeks gestation) to care in the index pregnancy. The IDIs focused on how patients' initial emotions about their pregnancy and their history of sPTB(s) impacted their initiation of PNC. IDIs were analyzed via applied thematic analysis. Results: We interviewed 41 individuals (28 early presenters and 13 late presenters). Nearly all early presenters and about half of the late presenters expressed feeling both positive emotions (e.g., excitement or happiness) and worry about their pregnancies. Participants were worried about having another sPTB or miscarriage or concerned about their baby's health. A few participants in both groups described intentionally delaying seeking care because they were worried. Also, a few early and late presenters felt uncertain about continuing their pregnancies. For a few late presenters, contemplating abortion or adoption delayed their PNC initiation; however, most participants (24 early, 4 late) sought PNC as soon as they learned they were pregnant. Conclusions: Positive emotions, worry, and uncertainty about pregnancy may influence timing of PNC initiation. These findings may inform postpartum counseling to improve the rate of patients with prior sPTB that present early during future pregnancies.