Changes in Timing of Prenatal Care Initiation: United States, 2021—2024

NCHS Data Brief No. 550, February 2026

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Michelle J.K. Osterman, M.H.S., and Joyce A. Martin, M.P.H.

Introduction

Early prenatal care initiation can improve the likelihood of a healthy pregnancy and baby (1). A recent report shows shifts in the timing of prenatal care initiation, with a decrease in care beginning in the first trimester and increases in care beginning in the second and third trimesters and for mothers who had received no care (2). This report describes trends in the timing of prenatal care initiation from 2016 (the first year for which national data are available based on the 2003 birth certificate revision) to 2024. Changes by maternal age, race and Hispanic origin, and late (beginning in the third trimester) or no care by state of residence also are shown from 2021 to 2024.

Trends

• From 2016 to 2021, prenatal care beginning in the first trimester increased 2% from 77.1% to 78.3%; care beginning in the second trimester decreased 8% from 16.7% to 15.4%; and late or no prenatal care fluctuated, ranging from 6.2% to 6.4% (Figure 1, Table 1).
• From 2021 to 2024, first trimester prenatal care declined 4%, from 78.3% to 75.5%.
• Prenatal care beginning in the second trimester increased 12% from 2021 to 2024, from 15.4% to 17.3%.
• Late or no care increased 16% from 2021 (6.3%) to 2024 (7.3%).

Maternal age

• Prenatal care beginning in the first trimester decreased, while care beginning in the second trimester and late or no care increased, for all maternal age groups from 2021 to 2024 (Figure 2, Table 2).
• The largest decrease in first trimester prenatal care was for mothers younger than age 20 (8%, from 61.6% to 56.7%), followed by mothers ages 20-29 (76.1% to 73.0%), 30-39 (82.0% to 79.3%), and 40 and older (78.0% to 75.3%).
• The largest increases in second trimester prenatal care were for mothers in their 30s (14%, from 13.0% to 14.8%), followed by mothers in their 20s (16.9% to 18.9%), mothers younger than 20 (25.6% to 28.5%), and mothers age 40 and older (16.2% to 17.7%).
• From 2021 to 2024, late or no care increased 16% to 18% for all age groups: from 12.7% to 14.8% for mothers younger than 20, 7.0% to 8.1% for mothers in their 20s, 5.0% to 5.9% for mothers in their 30s, and 5.9% to 6.9% for mothers age 40 and older.
• For both 2021 and 2024, mothers younger than 20 had the lowest percentage of prenatal care beginning in the first trimester and the highest percentages of second trimester and late or no care.

Race and Hispanic origin

• Prenatal care beginning in the first trimester decreased, while care beginning in the second trimester and late or no care increased, for nearly all race and Hispanic-origin groups from 2021 to 2024 (Figure 3, Table 3).
• The largest decrease in the percentage of mothers receiving prenatal care in the first trimester from 2021 to 2024 was for Native Hawaiian and Other Pacific Islander non-Hispanic (subsequently, Native Hawaiian and Other Pacific Islander) mothers at 8% (from 51.5% to 47.6%). This decrease was followed by Black non-Hispanic (subsequently, Black) (69.7% to 65.1%), Hispanic (72.5% to 67.8%), American Indian and Alaska Native non-Hispanic (subsequently, American Indian and Alaska Native) (65.8% to 64.0%), Asian non-Hispanic (subsequently, Asian) (83.5% to 80.8%), and White non-Hispanic (subsequently, White) (83.2% to 82.1%) mothers.
• The largest increase in second trimester prenatal care from 2021 to 2024 was among Hispanic mothers at 16% (from 19.1% to 22.2%), followed by Black (21.1% to 24.0%), Asian (12.4% to 13.9%), Native Hawaiian and Other Pacific Islander (27.4% to 29.7%), White (12.2% to 13.0%), and American Indian and Alaska Native (21.7% to 23.1%) mothers.
• The largest increase in late or no prenatal care from 2021 to 2024 was among Asian mothers at 29% (from 4.1% to 5.3%), followed by Black (9.1% to 10.9%), Hispanic (8.4% to 10.0%), Native Hawaiian and Other Pacific Islander (21.0% to 22.7%), and White (4.6% to 4.8%) mothers. The difference for American Indian and Alaska Native mothers (from 12.5% to 12.9%) was not significant.
• For both years, Native Hawaiian and Other Pacific Islander mothers had the lowest percentage of prenatal care beginning in the first trimester and the highest percentages of second trimester care and late or no care.

State of residence

• Late or no prenatal care increased in 36 states and the District of Columbia from 2021 to 2024 (Figure 4, Table 4).
• The largest increases in late or no prenatal care occurred in Utah (54%, from 3.7% to 5.7%), followed by Massachusetts (3.7% to 5.6%) and Rhode Island (1.4% to 2.1%).
• Late or no prenatal care decreased in six states: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia, and Wisconsin. The changes from 2021 to 2024 in eight states were not significant.

Summary

After increasing from 2016 to 2021, prenatal care beginning in the first trimester decreased each year from 2022 to 2024, when it reached 75.5%-lower than any year since national data became available again in 2016, based on the revised birth certificate. Over this time, corresponding increases were observed in prenatal care beginning in the second trimester, up 12% to 17.3%, and in late or no prenatal care, up 16% to 7.3%, which were the highest level for both since 2016.

From 2021 to 2024, first trimester prenatal care decreased with corresponding increases in second trimester and late or no care for all maternal age groups and for nearly all maternal race and Hispanic-origin groups (the difference in late or no care for American Indian and Alaskan Native mothers was not significant). Notably, in 2024, less than 50% of Native Hawaiian and Other Pacific Islander mothers received prenatal care in the first trimester.

Late or no care increased in 36 states and the District of Columbia. In 2024, more than 1 in every 10 mothers had late or no care in five states (Florida, Georgia, Hawaii, New Mexico, and Texas) and the District of Columbia.

Definitions

First trimester prenatal care: Care beginning in the first 3 months of pregnancy.

Second trimester prenatal care: Care beginning in the 4th to 6th months of pregnancy.

Late or no care: Prenatal care beginning in the 7th month of pregnancy or later and mothers receiving no prenatal care.

Data source and methods

This report uses data from the natality data file from the National Vital Statistics System. The vital statistics natality file is based on information from birth certificates and includes information for all births occurring in the United States (3).

The month in which prenatal care began is calculated from the "Date of the first prenatal visit" item on the birth certificate (the item also includes a checkbox for "No prenatal care") and the gestational age of the newborn based on the obstetric estimate of gestation (3). The month prenatal care began was missing from 1.9% to 2.9% of birth records for 2016 through 2024.

The race and Hispanic-origin groups shown in this report follow the 1997 Office of Management and Budget standards (4).

Differences between 2021 and 2024 noted in the text are statistically significant at the 0.05 level unless otherwise noted, based on a pairwise comparison, which was assessed using a two-tailed z test. Long-term trends were evaluated using the Joinpoint Regression Program (5).

About the authors

Michelle J.K. Osterman and Joyce A. Martin are with the National Center for Health Statistics, Division of Vital Statistics.

References

1. National Institute of Child Health and Human Development. What is prenatal care and why is it important? Available from: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care.
2. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2023. National Vital Statistics Report. 2025 Mar;74(1):1-87. DOI: https://dx.doi.org/10.15620/cdc/175204.
3. National Center for Health Statistics. User guide to the 2024 natality public use file. 2025. Available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2024.pdf.
4. Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Fed Regist. 1997;62(210):58782-90..
5. National Cancer Institute. Joinpoint Regression Program (Version 4.8.0.0) [computer software]. 2020.

Suggested citation

Osterman MJK, Martin JA. Changes in timing of prenatal care initiation: United States, 2021-2024. NCHS Data Brief. 2026 Feb;(550):1─11. DOI: https://dx.doi.org/10.15620/cdc/174642.

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

National Center for Health Statistics

Carolyn M. Greene, M.D., Acting Director
Amy M. Branum, Ph.D., Associate Director for Science

Division of Vital Statistics
Paul D. Sutton, Ph.D., Director
Andrés A. Berruti, Ph.D., M.A., Associate Director for Science