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Objective: To determine whether mothers who book early experience better birth preparedness, ANC investigations and pregnancy outcomes compared to those who book late.Design: A retrospective cohort study.Setting: Kenyatta National Hospital, Nairobi, Kenya.Study population: An exposed group of patients who had early booking ( 28weeks). Sample size: A total of 300 participants, 150 for each group.Results: Late booking was associated with lower odds of birth preparedness evidenced by: lower knowledge of expected date of delivery (OR 0.26; P=0.005; 95% CI 0.1-0.66), and lower likelihood of having a birth plan in terms of desired place of delivery, preferred skilled birth attendant, birth companion, means of transport and blood donor (OR 0.24; P=0.006; 95% CI 0.09-0.67). Late booking was also associated with lower odds of emergency preparedness like knowledge of danger signs during pregnancy (OR 0.09; P= |