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 describe the implementation and outcomes of an Eye Movement and Desensitisation Reprocessing (EMDR)-treatment-program for women with Posttraumatic stress disorder (PTSD) after childbirth. Design Prospective cohort-study with pre- and post measurements. Setting A large university hospital in the Netherlands. Population Women who gave birth to a living child at least 4 weeks ago, with a PTSD diagnosis, or severe PTSD-symptoms combined with another DSM-5 diagnosis, who provided written informed consent. Methods The intervention applied was EMDR, an evidence-based psychotherapy for patients with PTSD. Main Outcome Measures The PTSD Checklist for DSM-5 (PCL-5) was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5 (LEC-5), the Childhood Trauma Questionnaire (CTQ-SF) and the Childbirth Perception Scale (CPS). Results Forty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD anymore after on average 5 weekly sessions of EMDR-treatment. These outcomes are extra promising, as they were achieved in quite a complex group of women with relatively high psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%). Conclusions Implementing an EMDR-therapy treatment program for women with after childbirth PTSD in the context of a large academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualisation addressing the aetiology of the PTSD. Funding No external funding. Keywords Posttraumatic Stress Disorder after childbirth, EMDR-therapy, Psychiatry, Implementation.