Reducing inequalities through antenatal classes? Data from the Italian Surveillance System 0-2 years

Background

International policies and public health frameworks recognise parenting support as a key strategy to promote health during the first 1000 days of life; with antenatal education as a core component. This study describes antenatal classes (ACs) attendance in Italy and its association with adherence to recommended early childhood health practices among mothers.

Methods

Data were drawn from the Italian Surveillance System for children aged 0-2 years, a national, population-based survey conducted every three years to monitor early childhood health determinants. Mothers complete a self-administered questionnaire (available in 12 languages) during their child’s vaccination appointments. Maternal sociodemographic characteristics were collected. Multivariate Poisson regression models were used to assess associations between ACs attendance and adherence to recommended practices.

Results

In 2025, 64,789 mothers were enrolled across all Italian regions except Tuscany, (response rate 93%). Overall ACs attendance was 66% (69% among primiparous), with marked regional heterogeneity and higher coverage in Northern Italy. Participation increased with maternal age and education and was higher among Italian mothers and those reporting no economic difficulties. ACs attendance was independently associated with exclusively breastfeeding at 4–5 months (PR 1.35; 95%CI 1.27-1.45), safe sleep position (PR 1.08; 95%CI 1.06-1.11), shared reading (PR 1.17; 95%CI 1.14-1.20), and no screen exposure (PR 1.10, 95%CI 1.08-1.12).

Conclusions

The 2025 data show inequalities in ACs attendance, with lower participation among socially disadvantaged mothers. Participation is associated with a higher likelihood of adopting health‑protective behaviours in infancy. These findings support policies ensuring equitable access to antenatal education and strengthening its role in early childhood health promotion.

Key messages

• ACs attendance is linked to improved adoption of health-protective behaviours in infancy.

• The Italian Surveillance System 0–2 Years provides evidence on inequalities in access to ACs, informing equity-oriented policies.