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Kuppermann M, Pressman A, Coleman-Phox K, Afulani P, Blebu B, Carraway K, Butcher BC, Curry V, Downer C, Edwards B, Felder JN, Fontenot J, Garza MA, Karasek D, Lessard L, Martinez E, McCulloch CE, Oberholzer C, Ramirez GR, Tesfalul M, Wiemann A. A randomized comparative-effectiveness study of two enhanced prenatal care models for low-income pregnant people: Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE). Contemp Clin Trials 2024; 143:107568. [PMID: 38750950 DOI: 10.1016/j.cct.2024.107568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/18/2024] [Accepted: 05/04/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Improving perinatal mental health and care experiences and preventing adverse maternal and infant outcomes are essential prenatal care components, yet existing services often miss the mark, particularly for low-income populations. An enhanced group prenatal care program, "Glow! Group Prenatal Care and Support," was developed in California's Central Valley in response to poor perinatal mental health, disrespectful care experiences, and high rates of adverse birth outcomes among families with low incomes. METHODS Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE) is a pragmatic, two-arm, randomized, comparative-effectiveness study designed to assess depression (primary outcome), the experience of care (secondary outcome), and preterm birth (exploratory outcome) among Medi-Cal (California's Medicaid program)-eligible pregnant and birthing people, comparing those assigned to Glow! Group Prenatal Care and Support (Glow/GC) with those assigned to enhanced, individual prenatal care through the California Department of Public Health's Comprehensive Perinatal Services Program (CPSP/IC). Participating clinical practices offer the two comparators, alternating between comparators every 6 weeks, with the starting comparator randomized at the practice level. Participant-reported outcomes are assessed through interviewer-administered surveys at study entry, during the participant's third trimester, and at 3 months postpartum; preterm birth and other clinical outcomes are abstracted from labor and delivery records. Patient care experiences are further assessed in qualitative interviews. The protocol complies with the Standard Protocol Items for Randomized Trials. CONCLUSIONS This comparative-effectiveness study will be used to determine which of two forms of enhanced prenatal care is more effective, informing future decisions regarding their use. TRIAL REGISTRATION ClinicalTrials.gov: NCT04154423.
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Affiliation(s)
- Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; The California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Alice Pressman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America; The California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States of America
| | - Patience Afulani
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; The California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States of America
| | - Bridgette Blebu
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Kristin Carraway
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America
| | - Brittany Chambers Butcher
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, United States of America
| | - Venise Curry
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America
| | - Chris Downer
- Medical Education Program, University of California, San Francisco, Fresno, CA, United States of America
| | - Brittany Edwards
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America
| | - Jennifer N Felder
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America
| | - Jazmin Fontenot
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America; The California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States of America
| | - Mary A Garza
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America; Department of Public Health, College of Health and Human Services, California State University, Fresno, Fresno, CA, United States of America
| | - Deborah Karasek
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America; The California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States of America
| | - Lauren Lessard
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America; Institute for Circumpolar Health Studies, University of Alaska, Anchorage, Anchorage, AK, United States of America
| | - Erica Martinez
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Christy Oberholzer
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America
| | - Guadalupe R Ramirez
- Children and Families Commission of Fresno County, Fresno, CA, United States of America
| | - Martha Tesfalul
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America; The California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States of America
| | - Andrea Wiemann
- Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA, United States of America
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Roth I, Tiedt M, Brintz C, Thompson-Lastad A, Ferguson G, Agha E, Holcomb J, Gardiner P, Leeman J. Determinants of implementation for group medical visits for patients with chronic pain: a systematic review. Implement Sci Commun 2024; 5:59. [PMID: 38783388 PMCID: PMC11112917 DOI: 10.1186/s43058-024-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain. METHODS The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research. RESULTS Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting. CONCLUSIONS Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain. TRIAL REGISTRATION This systematic review was registered with PROSPERO 2021 CRD42021231310 .
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Affiliation(s)
- Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Malik Tiedt
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Health Studies and Applied Educational Psychology, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Carrie Brintz
- Department of Anesthesiology, Division of Pain Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ariana Thompson-Lastad
- Department of Family and Community Medicine, Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA, USA
| | - Gayla Ferguson
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Erum Agha
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Paula Gardiner
- Department of Family Medicine, Cambridge Health Alliance, University of Massachusetts Medical School, Boston, MA, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Avalos LA, Oberman N, Gomez L, Quesenberry CP, Sinclair F, Kurtovich E, Gunderson EP, Hedderson MM, Stark J. Group Multimodal Prenatal Care and Postpartum Outcomes. JAMA Netw Open 2024; 7:e2412280. [PMID: 38771574 PMCID: PMC11109777 DOI: 10.1001/jamanetworkopen.2024.12280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/19/2024] [Indexed: 05/22/2024] Open
Abstract
Importance An increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However, research is needed to evaluate outcomes of group multimodal prenatal care (GMPC), with groups delivered virtually in combination with individual in-person office appointments to collect vital signs and conduct other tests compared with individual multimodal prenatal care (IMPC) delivered through a combination of remotely delivered and in-person visits. Objective To compare postpartum outcomes between GMPC and IMPC. Design, Setting, and Participants A frequency-matched longitudinal cohort study was conducted at Kaiser Permanente Northern California, an integrated health care delivery system. Participants included 424 individuals who were pregnant (212 GMPC and 212 frequency-matched IMPC controls (matched on gestational age, race and ethnicity, insurance status, and maternal age) receiving prenatal care between August 17, 2020, and April 1, 2021. Participants completed a baseline survey before 14 weeks' gestation and a follow-up survey between 4 and 8 weeks post partum. Data analysis was performed from January 3, 2022, to March 4, 2024. Exposure GMPC vs IMPC. Main Outcome Measures Validated instruments were used to ascertain postpartum psychosocial outcomes (stress, depression, anxiety) and perceived quality of prenatal care. Self-reported outcomes included behavioral outcomes (breastfeeding initiation, use of long-acting reversible contraception), satisfaction with prenatal care, and preparation for self and baby care after delivery. Primary analyses included all study participants in the final cohort. Three secondary dose-stratified analyses included individuals who attended at least 1 visit, 5 visits, and 70% of visits. Log-binomial regression and linear regression analyses were conducted. Results The final analytic cohort of 390 participants (95.6% follow-up rate of 408 singleton live births) was racially and ethnically diverse: 98 (25.1%) Asian/Pacific Islander, 88 (22.6%) Hispanic, 17 (4.4%) non-Hispanic Black, 161 (41.3%) non-Hispanic White, and 26 (6.7%) multiracial participants; median age was 32 (IQR, 30-35) years. In the primary analysis, after adjustment, GMPC was associated with a 21% decreased risk of perceived stress (adjusted risk ratio [ARR], 0.79; 95% CI, 0.67-0.94) compared with IMPC. Findings were consistent in the dose-stratified analyses. There were no significant differences between GMPC and IMPC for other psychosocial outcomes. While in the primary analyses there was no significant group differences in perceived quality of prenatal care (mean difference [MD], 0.01; 95% CI, -0.12 to 0.15) and feeling prepared to take care of baby at home (ARR, 1.09; 95% CI, 0.96-1.23), the dose-stratified analyses documented higher perceived quality of prenatal care (MD, 0.16; 95% CI, 0.01-0.31) and preparation for taking care of baby at home (ARR, 1.27; 95% CI, 1.13-1.43) for GMPC among those attending 70% of visits. No significant differences were noted in patient overall satisfaction with prenatal care and feeling prepared for taking care of themselves after delivery. Conclusions In this cohort study, equivalent and, in some cases, better outcomes were observed for GMPC compared with IMPC. Health care systems implementing multimodal models of care may consider incorporating virtual group prenatal care as a prenatal care option for patients.
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Affiliation(s)
- Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California
| | - Nina Oberman
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lizeth Gomez
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Fiona Sinclair
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Elaine Kurtovich
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California
| | - Joanna Stark
- Regional Offices, Kaiser Permanente Northern California, Oakland
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Alvarez D, Adynski H, Harris R, Zou B, Taylor JY, Santos HP. Social Support Is Protective Against the Effects of Discrimination on Parental Mental Health Outcomes. J Am Psychiatr Nurses Assoc 2024:10783903241243092. [PMID: 38600825 DOI: 10.1177/10783903241243092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Discrimination, or unfair treatment based on individual characteristics such as gender, race, skin color, and or sexual orientation, is a pervasive social stressor that perpetuates health disparities by limiting social and economic opportunity and is associated with poor mental and physical health outcomes. AIMS The purpose of the present study is to (1) examine the association between maternal experiences of discrimination and paternal experiences of discrimination; (2) explore how discrimination relates to parental (maternal and paternal) stress and depressive symptoms; and (3) examine whether social support exerts protective effects. METHODS The sample was 2,510 mothers and 1,249 fathers from the Child Community Health Network study. Linear regression models were conducted to explore associations between maternal and paternal discrimination. In addition, mediation analyses were conducted to explore if social support functioned as a mediator between discrimination on parental stress and depressive symptoms. RESULTS Most mothers (40.3%) and fathers (50.7%) identified race as the predominant reason for discrimination. Experiencing discrimination was significantly related to stress and depressive symptoms for both parents, and all forms of social support mediated these relationships. Our findings suggest that social support can act as a protective factor against the negative association between discrimination and both stress and depressive symptoms. CONCLUSIONS These findings highlight the need to integrate social support into existing interventions and include fathers in mental health screenings in primary-care settings. Finally, we briefly describe the role of nurses and other allied health professionals in addressing discrimination in health care and health policy implications.
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Affiliation(s)
- Dallis Alvarez
- Dallis Alvarez, BSN, RN, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Harry Adynski
- Harry Adynski, PhD, RN, PMH-BC, University of California San Francisco, San Francisco, CA, USA
| | - Rebeca Harris
- Rebeca Harris BSN, RN, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Baiming Zou
- Baiming Zou, PhD, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacquelyn Y Taylor
- Jacquelyn Y. Taylor, PhD, RN, FAHA, FAAN, Columbia University, New York, NY, USA
| | - Hudson P Santos
- Hudson P. Santos Jr, PhD, RN, FAAN, University of Miami, Coral Gables, FL, USA
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Short VL, Hand DJ, Mancuso F, Raju A, Sinnott J, Caldarone L, Rosenthall E, Liveright E, Abatemarco DJ. Group prenatal care for pregnant women with opioid use disorder: Preliminary evidence for acceptability and benefits compared with individual prenatal care. Birth 2024; 51:144-151. [PMID: 37800365 DOI: 10.1111/birt.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The effectiveness of group prenatal care (G-PNC) compared with individual prenatal care (I-PNC) for women with opioid use disorder (OUD) is unknown. The objectives of this study were to (1) assess the acceptability of co-locating G-PNC at an opioid treatment program and (2) describe the maternal and infant characteristics and outcomes of pregnant women in treatment for OUD who participated in G-PNC and those who did not. METHODS This was a retrospective cohort study of 71 women (G-PNC n = 15; I-PNC n = 56) who were receiving treatment for OUD from one center and who delivered in 2019. Acceptability was determined by assessing the representativeness of the G-PNC cohorts, examining attendance at sessions, and using responses to a survey completed by G-PNC participants. The receipt of health services and healthcare use, behaviors, and infant health between those who participated in G-PNC and those who received I-PNC were described. RESULTS G-PNC was successfully implemented among women with varying backgrounds (e.g., racial, ethnic, marital status) who self-selected into the group. All G-PNC participants reported that they were satisfied to very satisfied with the program. Increased rates of breastfeeding initiation, breastfeeding at hospital discharge, receipt of the Tdap vaccine, and postpartum visit attendance at 1-2 weeks and 4-8 weeks were observed in the G-PNC group compared with the I-PNC group. Fewer G-PNC reported postpartum depression symptomatology. CONCLUSION Findings suggest that co-located G-PNC at an opioid treatment program is an acceptable model for pregnant women in treatment for OUD and may result in improved outcomes.
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Affiliation(s)
- Vanessa L Short
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dennis J Hand
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Amulya Raju
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jacqueline Sinnott
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Elizabeth Liveright
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Diane J Abatemarco
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Lenze SN, McKay-Gist K, Paul R, Tepe M, Mathews K, Kornfield S, Phillips C, Smith R, Stoermer A, Carter EB. Elevating Voices, Addressing Depression, Toxic Stress, and Equity Through Group Prenatal Care: A Pilot Study. Health Equity 2024; 8:87-95. [PMID: 38287981 PMCID: PMC10823176 DOI: 10.1089/heq.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. Methods We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. Results Forty-eight patients enrolled in the study (n=11 IC; n=14 CP; n=23 EleVATE GC) and 86% self-identified as Black. Patients participating in group prenatal care (EleVATE GC or CP) were significantly less likely to experience a preterm birth <34 weeks. Rates of small for gestational age, preterm birth <37 weeks, depression scores, and other pregnancy outcomes were similar across groups. Participants in CP and EleVATE GC were more likely to attend their postpartum visit and breastfeed at hospital discharge than those in IC. Discussion Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity.
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Affiliation(s)
- Shannon N. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Katherine Mathews
- SSM Health St. Mary's and Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, St. Louis, Missouri, USA
| | - Sara Kornfield
- Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheron Phillips
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Richelle Smith
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Amanda Stoermer
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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Carandang RR, Epel E, Radin R, Lewis JB, Ickovics JR, Cunningham SD. Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study. J Midwifery Womens Health 2024; 69:64-70. [PMID: 37358371 DOI: 10.1111/jmwh.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support. METHODS Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms. RESULTS Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects. DISCUSSION Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.
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Affiliation(s)
- Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
- Center for Health and Community, University of California San Francisco, San Francisco, California
| | - Rachel Radin
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
- Center for Health and Community, University of California San Francisco, San Francisco, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
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Cunningham SD, Carandang RR, Boyd LM, Lewis JB, Ickovics JR, Rickey LM. Psychosocial Factors Associated with Lower Urinary Tract Symptoms One Year Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:40. [PMID: 38248505 PMCID: PMC10815698 DOI: 10.3390/ijerph21010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04-1.11) and perceived stress (AOR 1.12, 95% CI 1.04-1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88-0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98-0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95-0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.
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Affiliation(s)
- Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Lisa M Boyd
- Virginia Polytechnic Institute, State University, Blacksburg, VA 24061, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology & Reproductive Services, Yale School of Medicine, New Haven, CT 06510, USA
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Keenan-Devlin L, Miller GE, Ernst LM, Freedman A, Smart B, Britt JL, Singh L, Crockett AH, Borders A. Inflammatory markers in serum and placenta in a randomized controlled trial of group prenatal care. Am J Obstet Gynecol MFM 2023; 5:101200. [PMID: 37875178 PMCID: PMC11325478 DOI: 10.1016/j.ajogmf.2023.101200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Racial and socioeconomic disparities in preterm birth and small for gestational age births are growing in the United States, increasing the burden of morbidity and mortality particularly among Black women and birthing persons and their infants. Group prenatal care is one of the only interventions to show potential to reduce the disparity, but the mechanism is unclear. OBJECTIVE The goal of this project was to identify if group prenatal care, when compared with individual prenatal care, was associated with a reduction in systemic inflammation during pregnancy and a lower prevalence of inflammatory lesions in the placenta at delivery. STUDY DESIGN The Psychosocial Intervention and Inflammation in Centering Study was a prospective cohort study that exclusively enrolled participants from a large randomized controlled trial of group prenatal care (the Cradle study, R01HD082311, ClinicalTrials.gov: NCT02640638) that was performed at a single site in Greenville, South Carolina, from 2016 to 2020. In the Cradle study, patients were randomized to either group prenatal care or individual prenatal care, and survey data were collected during the second and third trimesters. The Psychosocial Intervention and Inflammation in Centering Study cohort additionally provided serum samples at these 2 survey time points and permitted collection of placental biopsies for inflammatory and histologic analysis, respectively. We examined associations between group prenatal care treatment and a composite of z scored serum inflammatory biomarkers (C-reactive protein, interleukin-6, interleukin-1 receptor antagonist, interleukin-10, and tumor necrosis factor α) in both the second and third trimesters and the association with the prevalence of acute and chronic maternal placental inflammatory lesions. Analyses were conducted using the intent to treat principle, and the results were also examined by attendance of visits in the assigned treatment group (modified intent to treat and median or more number of visits) and were stratified by race and ethnicity. RESULTS A total of 1256 of 1375 (92%) Cradle participants who were approached enrolled in the Psychosocial Intervention and Inflammation in Centering Study, which included 54% of all the Cradle participants. The Psychosocial Intervention and Inflammation in Centering Study cohort did not differ from the Cradle cohort by demographic or clinical characteristics. Among the 1256 Psychosocial Intervention and Inflammation in Centering Study participants, 1133 (89.6%) had placental data available for analysis. Among those, 549 were assigned to group prenatal care and 584 of 1133 were assigned to individual prenatal care. In the intent to treat and modified intent to treat cohorts, participation in group prenatal care was associated with a higher serum inflammatory score, but it was not associated with an increased prevalence of placental inflammatory lesions. In the stratified analyses, group prenatal care was associated with a higher second trimester inflammatory biomarker composite (modified intent to treat: B=1.17; P=.02; and median or more visits: B=1.24; P=.05) among Hispanic or Latine participants. CONCLUSION Unexpectedly, group prenatal care was associated with higher maternal serum inflammation during pregnancy, especially among Hispanic or Latine participants.
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Affiliation(s)
- Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders).
| | - Gregory E Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, IL (Dr Miller)
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL (Dr Ernst); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
| | - Britney Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders)
| | - Jessica L Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC (Dr Britt)
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, IL (Ms. Singh)
| | - Amy H Crockett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health/University of South Carolina School of Medicine Greenville, Greenville SC (Dr Crockett)
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
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Park CH, Driver N, Richards RC, Ward P. The effects of CenteringPregnancy on maternal and infant health outcomes: a moderation analysis. J Public Health (Oxf) 2023; 45:e746-e754. [PMID: 37580870 DOI: 10.1093/pubmed/fdad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND CenteringPregnancy (CP) has been expected to produce beneficial outcomes for women and their infants. However, previous studies paid little attention to testing variations in CP's effects across women from different demographic groups. This study aimed to test how multiple demographic factors (obesity, race, ethnicity, marital status and socioeconomic status) moderate CP's effects on health outcomes. METHODS This study employed a quasi-experimental design. De-identified hospital birth data were collected from 216 CP participants and 1159 non-CP participants. We estimated the average treatment effect of CP on outcome variables as a baseline. Then we estimated the average marginal effect of CP by adding each of the moderating variables in regression adjustment models. RESULTS CP produced salutary effects among those who were obese or overweight and unmarried as well as women with lower socioeconomic status. These salutary effects were also strengthened as maternal age increased. However, CP was ineffective for Hispanic/Latinx women. CONCLUSIONS CP produced more beneficial health outcomes for high-risk women such as obese, unmarried women and those with lower socioeconomic status. These are meaningful findings from a public health perspective.
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Affiliation(s)
- Chul H Park
- Clinton School of Public Service, University of Arkansas, 1200 President Clinton Avenue, Little Rock, AR 72201, USA
| | - Nichola Driver
- Clinton School of Public Service, University of Arkansas, 1200 President Clinton Avenue, Little Rock, AR 72201, USA
| | - Robert C Richards
- Clinton School of Public Service, University of Arkansas, 1200 President Clinton Avenue, Little Rock, AR 72201, USA
| | - Penny Ward
- Psychiatric Research Institute, University of Arkansas for Medical Sciences 4301 W. Markham St. Little Rock, AR 72205, USA
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11
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Smith JC, Heberlein EC, Domingue A, LaBoy A, Britt J, Crockett AH. Randomized Controlled Trial on the Effect of Group Versus Individual Prenatal Care on Psychosocial Outcomes. J Obstet Gynecol Neonatal Nurs 2023; 52:467-480. [PMID: 37604352 PMCID: PMC10840617 DOI: 10.1016/j.jogn.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To assess the effect of group prenatal care (GPNC) compared with individual prenatal care (IPNC) on psychosocial outcomes in late pregnancy, including potential differences in outcomes by subgroups. DESIGN Randomized controlled trial. SETTING An academic medical center in the southeastern United States. PARTICIPANTS A total of 2,348 women with low-risk pregnancies who entered prenatal care before 20 6/7 weeks gestation were randomized to GPNC (n = 1,175) or IPNC (n = 1,173) and stratified by self-reported race and ethnicity. METHODS We surveyed participants during enrollment (M = 12.21 weeks gestation) and in late pregnancy (M = 32.51 weeks gestation). We used standard measures related to stress, anxiety, coping strategies, empowerment, depression symptoms, and stress management practices in an intent-to-treat regression analysis. To account for nonadherence to GPNC treatment, we used an instrumental variable approach. RESULTS The response rates were high, with 78.69% of participants in the GPNC group and 83.89% of participants in the IPNC group completing the surveys. We found similar patterns for both groups, including decrease in distress and increase in anxiety between surveys and comparable levels of pregnancy empowerment and stress management at the second survey. We identified greater use of coping strategies for participants in the GPNC group, particularly those who identified as Black or had low levels of partner support. CONCLUSION Group prenatal care did not affect stress and anxiety in late pregnancy; however, the increased use of coping strategies may suggest a benefit of GPNC for some participants.
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Moyett JM, Ramey-Collier K, Zambrano Guevara LM, MacDonald A, Kuller JA, Wheeler SM, Dotters-Katz SK. CenteringPregnancy: A Review of Implementation and Outcomes. Obstet Gynecol Surv 2023; 78:490-499. [PMID: 37594439 DOI: 10.1097/ogx.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Importance CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of breastfeeding, and higher rates of patient and clinician satisfaction. Objective The study aims to review the literature related to perinatal outcomes associated with CP, benefits and barriers to implementation, and utility of the model. Evidence An electronic-based search was performed in PubMed using the search terms "CenteringPregnancy" OR "Centering Pregnancy," revealing 221 articles. Results The CP model improves patient centeredness, efficiency, and equality in prenatal care. Challenges include administrative buy-in, limited resources, and financial support. Multisite retrospective studies of CP demonstrate improved maternal, neonatal, postpartum, and well-being outcomes, especially for participants from minority backgrounds; however, prospective studies had mixed results. CenteringPregnancy is feasibly implemented with high tenet fidelity in several low- and middle-income settings with improved perinatal outcomes compared with traditional care. Conclusions CenteringPregnancy is feasible to implement, largely accepted by communities, and shows positive qualitative and quantitative health outcomes. This body of literature supports CP as a potential tool for decreasing racial inequalities in prenatal access, quality of care, and maternal mortality. Further investigation is necessary to inform obstetric clinicians about the potential outcome differences that exist between group and traditional prenatal care.
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Affiliation(s)
- Julia M Moyett
- Medical Student, Duke University School of Medicine, Durham, NC
| | | | | | - Amy MacDonald
- Director, Group Care, Pomelo Care Affiliation, Bethesda, MD
| | | | | | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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Black with 'Baby Blues': A Systematic Scoping Review of Programs to Address Postpartum Depression in African American Women. Matern Child Health J 2023; 27:413-425. [PMID: 36729324 DOI: 10.1007/s10995-023-03589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The literature review reports on programs and interventions that address postpartum depression (PPD) in African American women. African American women are at a higher risk of developing PPD compared to white women. The review will highlight and recommend approaches that may render positive outcomes in the future for this population. METHODS A systematic scoping literature review was conducted using Academic Search Complete, CINAHL, APA PsycArticles, APA PsychInfo, PubMed, Social Services Abstracts, and Social Work Abstracts. Keywords used in the search included "postpartum depression," "African American," and "interventions OR programs OR therapy OR treatment." Fourteen studies were selected, analyzed, and included in the review. RESULTS Group psychosocial, individual psychosocial, internet-based, and integrated care interventions were included. While many articles noted within group changes in depression symptoms, fewer studies documented between group differences. Studies that investigated subsamples of "high risk" participants or those that used "culturally tailored" approaches showed promise. CONCLUSION The literature review yielded some examples of programs/interventions that target postpartum depression in African American women; however, results were mixed. More research is needed to confirm the most effective interventions to address postpartum depression in African American women.
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Crockett AH, Chen L, Heberlein EC, Britt JL, Covington-Kolb S, Witrick B, Doherty E, Zhang L, Borders A, Keenan-Devlin L, Smart B, Heo M. Group vs traditional prenatal care for improving racial equity in preterm birth and low birthweight: the Centering and Racial Disparities randomized clinical trial study. Am J Obstet Gynecol 2022; 227:893.e1-893.e15. [PMID: 36113576 PMCID: PMC9729420 DOI: 10.1016/j.ajog.2022.06.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The United States has persistently high rates of preterm birth and low birthweight and is characterized by significant racial disparities in these rates. Innovative group prenatal care models, such as CenteringPregnancy, have been proposed as a potential approach to improve the rates of preterm birth and low birthweight and to reduce disparities in these pregnancy outcomes. OBJECTIVE This study aimed to test whether participation in group prenatal care would reduce the rates of preterm birth and low birthweight compared with individual prenatal care and whether group prenatal care would reduce the racial disparity in these rates between Black and White patients. STUDY DESIGN This was a randomized controlled trial among medically low-risk pregnant patients at a single study site. Eligible patients were stratified by self-identified race and ethnicity and randomly allocated 1:1 between group and individual prenatal care. The primary outcomes were preterm birth at <37 weeks of gestation and low birthweight of <2500 g. The primary analysis was performed according to the intent-to-treat principle. The secondary analyses were performed according to the as-treated principle using modified intent-to-treat and per-compliance approaches. The analysis of effect modification by race and ethnicity was planned. RESULTS A total of 2350 participants were enrolled, with 1176 assigned to group prenatal care and 1174 assigned to individual prenatal care. The study population included 952 Black (40.5%), 502 Hispanic (21.4%), 863 White (36.8%), and 31 "other races or ethnicity" (1.3%) participants. Group prenatal care did not reduce the rate of preterm birth (10.4% vs 8.7%; odds ratio, 1.22; 95% confidence interval, 0.92-1.63; P=.17) or low birthweight (9.6% vs 8.9%; odds ratio, 1.08; 95% confidence interval, 0.80-1.45; P=.62) compared with individual prenatal care. In subgroup analysis, greater attendance in prenatal care was associated with lower rates of preterm birth and low birthweight. This effect was most noticeable for the rates of low birthweight for Black participants in group care: intent to treat (51/409 [12.5%]), modified intent to treat (36/313 [11.5%]), and per compliance (20/240 [8.3%]). Although the rates of low birthweight were significantly higher for Black participants than White participants seen in individual care (adjusted odds ratio, 2.00; 95% confidence interval, 1.14-3.50), the difference was not significant for Black participants in group care compared with their White counterparts (adjusted odds ratio, 1.58; 95% confidence interval, 0.74-3.34). CONCLUSION There was no difference in the overall rates of preterm birth or low birthweight between group and individual prenatal care. With increased participation in group prenatal care, lower rates of preterm birth and low birthweight for Black participants were observed. The role of group care models in reducing racial disparities in these birth outcomes requires further study.
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Affiliation(s)
- Amy H Crockett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health and the University of South Carolina School of Medicine, Greenville, SC.
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Emily C Heberlein
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA
| | - Jessica L Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC
| | - Sarah Covington-Kolb
- Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Brian Witrick
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Emily Doherty
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Lu Zhang
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Britney Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
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Gresh A, Abrams ET, Chirwa E, Jere DL, Chodzaza E, Chorwe-Sungani G, Kafulafula U, Kapito E, Patel DR, Jeremiah RD, Klima CS, MacDonald A, Norr KF, Patil CL. Experiential Training Workshops for Group Antenatal Care in Malawi. J Midwifery Womens Health 2022; 67:759-769. [PMID: 36433698 PMCID: PMC10239291 DOI: 10.1111/jmwh.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
The positive effects of the CenteringPregnancy group antenatal care (ANC) model on perinatal outcomes in the United States has led to its adaptation and implementation in many low- and middle-income countries. Facilitative discussions are a core component of this group ANC model. Facilitator training lays a critical foundation for delivery of this paradigm-shifting model as practitioners learn to adapt their approach to health education from didactive to facilitative. However, there is little rigorous research focused on best practices for training group health care facilitators and none that is guided by a theoretical framework. Kolb's experiential learning theory offers a theoretical framework to guide the development of training workshops that allow trainees to experience, reflect on, and practice the facilitation skills needed to deliver this evidence-based intervention. This article describes an experiential learning-based training workshop that was implemented as part of an ongoing effectiveness-implementation trial of a Centering-based group ANC model in Blantyre District, Malawi. We provide a blueprint for conducting group ANC facilitator trainings that, in addition to imparting knowledge, effectively builds confidence and buy-in to this paradigm-changing approach to ANC delivery. This blueprint can be adapted for use in designing and implementing group health care across settings in the United States and globally.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Elizabeth T Abrams
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Ellen Chirwa
- Department of Midwifery, School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Diana L Jere
- School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Chodzaza
- Department of Midwifery, School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Genesis Chorwe-Sungani
- Institute of Postgraduate Studies and Research, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ursula Kafulafula
- School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esnath Kapito
- School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Dhruvi R Patel
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Rohan D Jeremiah
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Carrie S Klima
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Amy MacDonald
- Group Care Programs, Pomelo Care, Hillsborough, North Carolina
- Group Care Global, Philadelphia, Pennsylvania
| | - Kathleen F Norr
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Crystal L Patil
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
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16
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Impact of Group vs. Individual Prenatal Care Provision on Women’s Knowledge of Pregnancy-Related Topics: An Open, Controlled, Semi-Randomized Community Trial. J Clin Med 2022; 11:jcm11175015. [PMID: 36078944 PMCID: PMC9457062 DOI: 10.3390/jcm11175015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
The importance of acquiring knowledge of pregnant women on prenatal care lies in its leading to confidence and ability in decision-making. There is a growing need for a model of prenatal care that will allow nurses to provide the most efficient pregnancy-related guidance with minimum need for additional staff. This study compares the level of knowledge on subjects pertaining to pregnancy and birth in low-risk pregnancies when delivered in group versus individual settings. The study is an open, controlled, semi-randomized community trial. The intervention arm received prenatal care services in a group setting led by a nurse. The control arm received prenatal care services in routine individual meetings with a nurse. Knowledge of prenatal subjects was evaluated by questionnaires. The level of knowledge of the women in the group setting for the pre-service questionnaire was lower than that of the women in the individual group, but higher for the final questionnaire. After accounting for a starting point difference (the women in the individual care arm started with a higher knowledge score), the women in the group setting had a three-fold improvement in score compared to the women in the individual setting (p = 0.043). Prenatal care provided in a group setting may lead to better knowledge acquisition, leading to better awareness of pregnancy-related medical conditions and to enhanced adherence to recommended pregnancy tests and healthy lifestyle.
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17
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Fairchild E, Kyle S, Marion S, Cheatham A, Lecky T, Harris S, Jensen S. Prenatal Considerations and Outcomes for Girls Aged 14 and Under: Development of a Multidisciplinary Team in a Large Tertiary Care Facility. J Midwifery Womens Health 2022; 67:504-509. [PMID: 35713367 DOI: 10.1111/jmwh.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adolescent girls account for 11% of all births that occur globally every year. Among developing countries, the United States continues to have one of the highest adolescent birth rates, despite a decreasing trend between 1990 and 2010. Pregnant adolescents are a vulnerable population who are at increased risk for maternal morbidity and mortality. Additional risks are noted within the early adolescent population, usually defined as age 10 to 14. PROCESS At Parkland hospital, a large tertiary care facility in Dallas, Texas, a multidisciplinary team was created in 2017 to care for this vulnerable population. The team consisted of a certified nurse-midwife (CNM), a Certified Child Life Specialist, a maternal fetal medicine physician, a social worker, and a Spanish interpreter, with additional services consulted as needed. Between 2017 and 2020, this team grew to include 8 CNMs and provided care to 76 young adolescents ages 14 and younger. OUTCOMES Of the young adolescents who attended prenatal visits with the Adolescent Prenatal Care Team at Parkland, 87% presented to Parkland for birth. Eighteen percent had pregnancy-induced hypertension or eclampsia. Only 7% of adolescents in the program gave birth prior to 37 weeks. Seventy-four percent had vaginal births. Sixty percent of the adolescents attended known postpartum visits. DISCUSSION In contrast to most studies, this Adolescent Care Team did not find a high rate of premature birth in early adolescents. Further work by this team is needed to compare the data obtained during this period with data on similar adolescents who have given birth at Parkland in prior years. In addition, comparing outcomes of early adolescents with those aged 15 to 19, who were not included in the Adolescent Care Team, will help to understand the impact that such a team or similar intervention might have on this vulnerable population.
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Affiliation(s)
- Esther Fairchild
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
| | - Sara Kyle
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
| | - Shirley Marion
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
| | - Allyson Cheatham
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
| | - Tashein Lecky
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
| | - Shalawn Harris
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
| | - Sarah Jensen
- Women & Infants Specialty Health, Parkland Health and Hospital Systems, Dallas, Texas
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18
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Psychosocial outcomes of group prenatal care. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Yang ST, Yang SQ, Duan KM, Tang YZ, Ping AQ, Bai ZH, Gao K, Shen Y, Chen MH, Yu RL, Wang SY. The development and application of a prediction model for postpartum depression: optimizing risk assessment and prevention in the clinic. J Affect Disord 2022; 296:434-442. [PMID: 34606808 DOI: 10.1016/j.jad.2021.09.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preventive intervention can significantly reduce the human and economic costs of postpartum depression (PPD) compared with treatment post-diagnosis. However, identifying women with a high PPD risk and making a judgement as to the benefits of preventive intervention is a major challenge. METHODS This is a retrospective study of parturients that underwent a cesarean delivery. Control group was used as development cohort and validation cohort to construct the risk prediction model of PPD and determine a risk threshold. Ketamine group and development cohort were used to verify the risk classification of parturients by evaluating whether the incidence of PPD decreased significantly after ketamine treatment in high-risk for PPD population. RESULTS The AUC for the development cohort and validation cohort of the PPD prediction model were 0.751 (95%CI:0.700-0.802) and 0.748 (95%CI:0.680-0.816), respectively. A threshold of 19% PPD risk probability was determined, with a specificity and sensitivity in the validation cohort are 0.766 and 0.604, respectively. After matching the high-risk group and the low-risk group by propensity score, the results demonstrated that PPD incidence significantly reduced in the high-risk group following ketamine, versus non-ketamine, intervention (p < 0.01). In contrast, intervention in the low-risk group showed no significant difference in PPD outcomes (p > 0.01). LIMITATION Randomized trials are needed to further verify the feasibility of the model and the thresholds proposed. CONCLUSION This prediction model developed in this study shows utility in predicting PPD risk. Ketamine intervention significantly lowers PPD incidence in parturients with a risk classification threshold greater than 19%.
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Affiliation(s)
- Shu-Ting Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Si-Qi Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Kai-Ming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Yong-Zhong Tang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China; Hunan Key Laboratory of Brain Homeostasis, China
| | - An-Qi Ping
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Zhi-Hong Bai
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Kai Gao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Yang Shen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Ming-Hua Chen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Ri-Li Yu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Sai-Ying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China.
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20
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Group Medical Care: A Systematic Review of Health Service Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312726. [PMID: 34886452 PMCID: PMC8657170 DOI: 10.3390/ijerph182312726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.
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21
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Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med 2021; 153:106853. [PMID: 34678329 DOI: 10.1016/j.ypmed.2021.106853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
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Affiliation(s)
- Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Sonia S Hassan
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States of America
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Marisa G Rodriguez
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
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22
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Jeremiah RD, Patel DR, Chirwa E, Kapito E, Mei X, McCreary LL, Norr KF, Liu L, Patil CL. A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania. BMC Pregnancy Childbirth 2021; 21:790. [PMID: 34819018 PMCID: PMC8611988 DOI: 10.1186/s12884-021-04267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.
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Affiliation(s)
- Rohan D Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, USA.
| | - Dhruvi R Patel
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Xiaohan Mei
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Kathleen F Norr
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Li Liu
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, Chicago, USA
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23
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Vandermorris A, McKinnon B, Sall M, Witol A, Traoré M, Lamesse-Diedhiou F, Bassani DG. Adolescents' experiences with group antenatal care: Insights from a mixed-methods study in Senegal. Trop Med Int Health 2021; 26:1700-1708. [PMID: 34669987 DOI: 10.1111/tmi.13692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Group antenatal care (G-ANC) is an innovative model in which antenatal care is delivered to a group of 8-12 women of similar gestational age. Evidence from high-income countries suggests G-ANC is particularly effective for women from marginalised populations, including adolescents. The objective of this study was to examine the experiences of Senegalese adolescents engaged in group antenatal care. METHODS This convergent parallel mixed-methods study is derived from a larger effectiveness-implementation hybrid pilot study conducted in Kaolack district, Senegal. Quantitative data for adolescent participants were collected through baseline and postnatal surveys and descriptively analysed. One-on-one interviews and focus-group discussions were conducted with adolescent participants, and qualitative data were analysed using qualitative descriptive analysis. RESULTS Forty-five adolescents aged 15-19 participated in G-ANC, with a median age of 18 years. The majority (93.3%) were married, and 64.4% were nulliparous. Findings indicated similar levels of G-ANC participation for adolescent and adult women. The majority (93.1%) of participants who had previously attended individual ANC indicated they would prefer G-ANC to individual care for a future pregnancy. Qualitative findings indicated key facets of consideration relevant to G-ANC for adolescents include social connectedness, the influence of social norms and the opportunity for engagement in healthcare. CONCLUSIONS This study suggests that G-ANC has the potential to be an adolescent-responsive and culturally appropriate method of delivering antenatal care in Senegal.
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Affiliation(s)
- Ashley Vandermorris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Britt McKinnon
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohamadou Sall
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Adrian Witol
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mahamadou Traoré
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Fatma Lamesse-Diedhiou
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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24
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017-2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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25
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Liu Y, Wang Y, Wu Y, Chen X, Bai J. Effectiveness of the CenteringPregnancy program on maternal and birth outcomes: A systematic review and meta-analysis. Int J Nurs Stud 2021; 120:103981. [PMID: 34098451 DOI: 10.1016/j.ijnurstu.2021.103981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The World Health Organization has emphasized the critical role of prenatal care in achieving the Millennium Development Goals to reduce child and maternal mortality. The CenteringPregnancy program is a widely recognized model of prenatal care. Several countries have attempted to implement the program in prenatal care practice; however, its effectiveness on maternal and birth outcomes has not been systematically evaluated and analyzed. OBJECTIVES To determine the effect of the CenteringPregnancy program on improving maternal and birth outcomes, including low birth weight, preterm birth, and postpartum depression. DESIGN This study evaluated and analyzed randomized controlled trials by comparing the CenteringPregnancy program with o0bstetric led prenatal care. Maternal and birth outcomes of interest included low birthweight, preterm birth, and postpartum depressive symptoms. DATA SOURCES Embase, PubMed, CINAHL, Web of Science, and The Cochrane Library were utilized in this systematic review. Additionally, a supplemental Google Scholar search was performed to capture all relevant articles. METHODS All data were extracted independently by two trained researchers, who evaluated the quality of the study by examining the risk of bias. The biases of selection, allocation, measurement, reporting, and loss of follow-up were assessed using the Cochrane risk of bias for these included randomized controlled trials. A meta-analysis of eligible randomized controlled trials was conducted using Review Manager. Heterogeneity of studies was assessed using the I2 statistic. RESULTS Out of 591 articles reviewed, seven randomized controlled trials were included in this study. Findings showed that the CenteringPregnancy program was not associated with lower rates of preterm birth (0.88 [0.71-1.07], p = 0.20, I2 = 0%), low birth weight (0.87 [0.68-1.12], p =0.29, I2 = 0%), or 12-month postpartum depressive symptoms (0.07 [-0.12-0.26], p =0.46, I2 = 69%). However, the CenteringPregnancy program was associated with reduced rates of 6-month postpartum depressive symptoms (0.49 [0.40-0.59], p < 0.01, I2 = 40%). CONCLUSIONS Existing evidence suggests that the CenteringPregnancy program and obstetric led care have similar effects on reducing the rates of preterm birth and low birth weight but different effects on postpartum depressive symptoms. More studies are needed to examine the effect of the CenteringPregnancy program on the improvement of postpartum depressive symptoms. PROSPERO Registration number: CRD42020171831. Tweetable abstract: We conducted a systematic review and meta-analysis of randomized controlled trials to determine the effects of the CenteringPregnancy program on improving maternal and birth outcomes, including low birth weight, preterm birth, and postpartum depressive symptoms. Seven randomized controlled trials were included in this study. The findings suggested that the CenteringPregnancy program and obstetric led care had similar effects in reducing the rates of preterm birth and low birth weight. More studies are needed to examine the effect of the CenteringPregnancy program on the improvement of postpartum depressive symptoms.
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Affiliation(s)
- Yanqun Liu
- School of Health Sciences, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Yuchen Wang
- School of Health Sciences, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Yinyin Wu
- School of Health Sciences, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Xiaoli Chen
- School of Health Sciences, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA.
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26
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McCloskey L, Bernstein J, The Bridging The Chasm Collaborative, Amutah-Onukagha N, Anthony J, Barger M, Belanoff C, Bennett T, Bird CE, Bolds D, Brenna BW, Carter R, Celi A, Chachere B, Crear-Perry J, Crossno C, Cruz-Davis A, Damus K, Dangel A, Depina Z, Deroze P, Dieujuste C, Dude A, Edmonds J, Enquobahrie D, Eromosele E, Ferranti E, Fitzmaurice M, Gebel C, Blount LG, Greiner A, Gullo S, Haddad A, Hall N, Handler A, Headen I, Heelan-Fancher L, Hernandez T, Johnson K, Jones E, Jones N, Klaman S, Lund B, Mallampalli M, Marcelin L, Marshall C, Maynard B, McCage S, Mitchell S, Molina R, Montasir S, Nicklas J, Northrup A, Norton A, Oparaeke E, Ramos A, Rericha S, Rios E, Bloch JR, Ryan C, Sarfaty S, Seely E, Souter V, Spain M, Spires R, Theberge S, Thompson T, Wachman M, Yarrington T, Yee LM, Zera C, Clayton J, Lachance C. Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action. Womens Health Issues 2021; 31:204-218. [PMID: 33707142 PMCID: PMC8154664 DOI: 10.1016/j.whi.2021.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
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Affiliation(s)
- Lois McCloskey
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1..
| | - Judith Bernstein
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1
| | | | | | | | - Mary Barger
- University of San Diego, Hahn School of Nursing
| | | | - Trude Bennett
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | - Ann Celi
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Chase Crossno
- University of North Texas Health Sciences Center/Texas Christian University School of Medicine
| | | | - Karla Damus
- Boston University Medical Campus, Office of Human Research Affairs
| | | | | | | | | | - Annie Dude
- University of Chicago School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | - Arden Handler
- University of Illinois at Chicago School of Public Health
| | - Irene Headen
- Drexel University Dornsife School of Public Health
| | | | | | | | - Emily Jones
- University of Oklahoma Health Sciences Center, Ziegler College of Nursing
| | | | - Stacey Klaman
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | | | | | | | - Rose Molina
- Beth Israel Deaconess Medical Center / The Dimock Center
| | | | | | | | | | | | | | | | | | | | | | | | - Ellen Seely
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | | | | | | | - Madi Wachman
- Boston University Center for Innovation in Social Work and Health
| | | | - Lynn M Yee
- Northwestern University, Feinberg School of Medicine
| | - Chloe Zera
- Beth Israel Deaconess Medical Center, Harvard Medical School
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27
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Malebranche M, Norrie E, Hao S, Brown G, Talavlikar R, Hull A, De Vetten G, Nerenberg KA, Metcalfe A, Fabreau G. Antenatal Care Utilization and Obstetric and Newborn Outcomes Among Pregnant Refugees Attending a Specialized Refugee Clinic. J Immigr Minor Health 2021; 22:467-475. [PMID: 31853807 DOI: 10.1007/s10903-019-00961-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of the study is to characterize the antenatal care utilization and obstetric and newborn outcomes among refugee women at a specialized refugee clinic and determine whether these outcomes varied between refugees (government-assisted or privately-sponsored) and asylum seekers. This retrospective cohort study included women receiving antenatal care at a specialized refugee clinic between 2011 and 2016. Time from arrival to first clinic visit, Adequacy of Prenatal Care Utilization Index, and obstetric and newborn outcomes were examined, stratified by refugee category. Amongst 179 women, median time from arrival to first clinic visit was longer for asylum seekers (2.8 months, IQR 12.9) compared to government-assisted and privately-sponsored refugees (0.4 months, IQR 0.7, and 1.6 months, IQR 3.2, respectively; p < 0.01). A larger proportion of asylum seeking women received inadequate antenatal care. No difference was found in obstetric and newborn outcomes. Differences in antenatal care utilization between refugee categories suggest that barriers may remain for asylum seekers; however, obstetric and newborn outcomes were comparable amongst refugee categories.
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Affiliation(s)
| | - Eric Norrie
- Mosaic Refugee Health Clinic, Calgary, Canada
| | | | | | | | - Andrea Hull
- Mosaic Refugee Health Clinic, Calgary, Canada
| | | | - Kara A Nerenberg
- Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Gabriel Fabreau
- Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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28
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Abstract
Group prenatal care is a health care delivery model that utilizes shared medical appointments to place greater focus on patient education, mutual support, and increased time with the clinician to promote a healthy pregnancy. Several studies suggest that medically low-risk women participating in group prenatal care have improved pregnancy outcomes, but the same tenants can likely be used to help women with diabetes and obesity achieve healthy outcomes during pregnancy and throughout their life course. This chapter will review the background, care model, and evidence regarding group medical visits for pregnant women with diabetes and obesity.
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Affiliation(s)
- Bridget C Huysman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Sara Mazzoni
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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29
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McKinney J, Jackson J, Sangi-Haghpeykar H, Hickerson L, Hawkins J, Peters Y, Levison J. HIV-Adapted Group Prenatal Care: Assessing Viral Suppression and Postpartum Retention in Care. AIDS Patient Care STDS 2021; 35:39-46. [PMID: 33571047 DOI: 10.1089/apc.2020.0249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Viral suppression and postpartum retention in care have far-reaching health implications for pregnant women living with HIV and their children, yet remain public health challenges. Prenatal care presents a unique opportunity to engage pregnant women in care. The purpose of this study is to evaluate whether group prenatal care is effective in impacting these outcomes for pregnant women living with HIV. A retrospective cohort study was performed of all women living with HIV who obtained prenatal care from a community-based health center between 2013 and 2019. Women who spoke English or Spanish, remained within the system, and had not participated in group prenatal care previously were included. Women self-selected a prenatal care model: 85 selected group care and 109 elected individual care. Group prenatal care followed a standard Centering Pregnancy® curriculum with the addition of HIV-related topics. The primary outcomes of the study were viral suppression (viral load <20 copies/mL) and postpartum retention in care (attending at least one or two visits with HIV primary care within 12 months postpartum). After adjusting for potential confounding factors, women who participated in group prenatal care were significantly more likely to have at least one HIV primary care visit postpartum {adjusted odds ratio (aOR) = 2.71 [95% confidence interval (CI 1.14-6.46)]; p = 0.024}, and had a trend for achieving viral suppression by the time of delivery [aOR = 2.29 (95% CI 0.94-5.55); p = 0.068]. We have demonstrated that group prenatal care for pregnant women living with HIV is feasible and effective, with positive impacts on retention in care and viral suppression, factors that affect long-term outcomes from patients living with HIV.
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Affiliation(s)
- Jennifer McKinney
- Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA
| | - Josef Jackson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Haleh Sangi-Haghpeykar
- Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA
| | - Latia Hickerson
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Yvette Peters
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
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Buultjens M, Farouque A, Karimi L, Whitby L, Milgrom J, Erbas B. The contribution of group prenatal care to maternal psychological health outcomes: A systematic review. Women Birth 2020; 34:e631-e642. [PMID: 33358645 DOI: 10.1016/j.wombi.2020.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
PROBLEM Poor mental health remains a significant cause of morbidity for childbearing women globally. BACKGROUND Group care has been shown to be effective in reducing select clinical outcomes, e.g., the rate of preterm birth, but less is known about the effect of Group Prenatal Care (GPC) on mental health outcomes of stress, depression and anxiety in pregnant women. AIM To conduct a systematic review of the current evidence of the effect of group pregnancy care on mental health and wellbeing outcomes (i.e., stress, depression and/or anxiety) in childbearing women. METHODS A comprehensive search of published studies in Medline, PsychInfo, CINAHL, ProQuest databases, ClinicalTrials.gov and Google Scholar. Databases were systematically searched without publication period restriction until Feb 2020. Inclusion criteria were randomized controlled trials (including quasi-experimental) and observational studies comparing group care with standard pregnancy care. Included were studies published in English, whose primary outcome measures were stress, depression and/or anxiety. RESULTS Nine studies met the inclusion criteria, five randomized controlled trials and four observational studies, involving 1585 women (39%) in GPC and 2456 women (61%) in standard (individual) pregnancy care. Although evidence is limited, where targeted education was integrated into the group pregnancy care model, significant reductions in depressive symptoms were observed. In addition, secondary analysis across several studies identified a subset of GPC women, i.e., higher risk for psychological symptoms, who reported a decrease in their depression, stress and anxiety symptoms, postpartum. Due to the diversity of group care structure and content and the lack of outcomes measures universally reported, a comprehensive meta-analysis could not be performed. CONCLUSION The evidence suggests improvements in some markers of psychological health outcomes with group pregnancy care. Future research should involve larger well-designed studies encompassing cross-population data using a validated scale that is comparable across diverse childbearing populations and clinical settings to better understand the impact of group pregnancy care.
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Affiliation(s)
- Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
| | - Ambereen Farouque
- School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
| | - Linda Whitby
- La Trobe University Library Research, La Trobe University, Bundoora, 3086, Victoria, Australia.
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia.
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
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Nichols CR, Cohen AK. Preventing maternal mortality in the United States: lessons from California and policy recommendations. J Public Health Policy 2020; 42:127-144. [PMID: 33268845 DOI: 10.1057/s41271-020-00264-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 11/21/2022]
Abstract
Maternal mortality remains a large concern in the United States (US), although other Western countries are making progress. In this scoping review, we identify four problems that may contribute to the maternal mortality burden in the US: inadequately investing in women's health, poor quality of care, increasing disparities, and poor data collection and monitoring of maternal health issues. Because maternal mortality is decreasing in California, we identify strategies implemented there that could improve maternal health outcomes nationwide: funding programs to address social determinants of maternal health; supporting health care strategies to improve maternal health (including national standards and goals for health care systems); and investing in maternal health monitoring and surveillance (including use of technology). We encourage researchers, practitioners, and policymakers to work together to develop evidence-based policies and practices to improve maternal health and reduce maternal. We conclude with recommendations for the United States and globally.
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Affiliation(s)
- Chloe R Nichols
- Department of Public and Nonprofit Management, School of Management, University of San Francisco, San Francisco, USA
| | - Alison K Cohen
- Department of Epidemiology & Population Health, School of Medicine, Stanford University, Stanford, USA.
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McKinney J, Hickerson L, Guffey D, Hawkins J, Peters Y, Levison J. Evaluation of human immunodeficiency virus-adapted group prenatal care. Am J Obstet Gynecol MFM 2020; 2:100150. [PMID: 33345881 DOI: 10.1016/j.ajogmf.2020.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Efforts to further decrease perinatal transmission of HIV include efforts to improve engagement and retention in prenatal care. Group prenatal care has been reported to have benefits in certain other high-risk groups of pregnant women but has not been previously evaluated in pregnant women living with HIV. OBJECTIVE This study aimed to evaluate changes in HIV knowledge, stigma, social support, depression, self-efficacy, and medication adherence after HIV-adapted group prenatal care. STUDY DESIGN All women living with HIV who presented for prenatal care at ≤30 weeks' gestation in Harris Health System (Houston, TX) between September 2013 and December 2017 were offered either group or individual HIV-focused prenatal care. Patients were recruited for the study at their initial prenatal visit. HIV topics, such as HIV facts, disclosure, medication adherence, safe sex and conception, retention in care, and postdelivery baby testing, were added to the standard CenteringPregnancy curriculum (ten 2-hour sessions per pregnancy). Knowledge and attitudes toward factors associated with adherence to HIV treatment regimens (stigma, loneliness, perceived social support, and depressive symptoms) were compared on written pre- and postsurveys. Surveys included 58 items derived from validated scales, with Likert and dichotomous responses. McNemar's test, Wilcoxon signed-rank test, and paired t-tests compared pre- and postsurvey responses. RESULTS A total of 190 women living with HIV received prenatal care in the clinic during the study period, 93 (49%) of whom participated in CenteringHIV. A total of 66 Centering participants enrolled in the study and 42 of those completed the pre- and postsurveys. Among women in the Centering program who completed pre- and postsurveys, significant differences were noted with improved perceived social support from family (P=.011) and friends (P=.005), decreased depression (Edinburg Postnatal Depression Scale, ≥10; 43% vs 18%; P<.001; Edinburg Postnatal Depression Scale score mean (standard deviation), 9.3 (5.8) pre vs 5.2 (4.9) post; P<.001), and decreased missed medication doses related to depressed mood (P=.014). No statistically significant differences were noted in HIV knowledge, HIV stigma, attitude, or self-efficacy. CONCLUSION HIV-focused group prenatal care may positively affect perceived social support and depression scores, factors that are closely associated with antiretroviral adherence and retention in the care for pregnant women living with HIV.
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Affiliation(s)
- Jennifer McKinney
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | - Latia Hickerson
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX; School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Yvette Peters
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX
| | - Judy Levison
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX.
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Mazzoni S, Hill P, Briggs A, Barbier K, Cahill A, Macones G, Colditz G, Tuuli M, Carter E. The effect of group prenatal care for women with diabetes on social support and depressive symptoms: a pilot randomized trial. J Matern Fetal Neonatal Med 2020; 33:1505-1510. [PMID: 30251569 DOI: 10.1080/14767058.2018.1520832] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/19/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
Objective: To measure the impact of group prenatal care (GPC) on diabetes-specific peer support and depressive symptoms in women with pregnancies complicated by diabetes.Materials and methods: This is a planned secondary analysis of a two-center pilot randomized controlled trial conducted at Denver health (DH) and Washington University in St. Louis (WU) including Spanish (DH) or English (WU) speaking women with type 2 or gestational diabetes. Women were randomized to diabetes GPC or individual prenatal care (IPC) in the resident diabetes clinic. Participants completed an Edinburgh Postnatal Depression Scale (EPDS) at randomization, at 38-week gestation and at 6-12 weeks postpartum. The diabetes support scale (DSS), which includes 12 questions answered on a Likert scale, was administered at 38 weeks. Analysis was by intention to treat (clincaltrials.gov#NCT02444325).Results: A total of 84 women were consented and randomized. Six withdrew consent (two from each cohort) or were lost to follow-up (two from IPC), and three did not complete the 38-week assessment (two from GPC and one from IPC), resulting in primary outcome data available for 75 women: 38 in GPC and 37 in IPC. More women randomized to GPC reported composite positive peer support on the DSS (52.5 versus 26.3%; p < .02). There were no differences in EPDS scores, depression (EPDS >10), or rates of improved EPDS score from baseline to 38 weeks.Conclusion: GPC for women with diabetes is associated with improved diabetes-specific peer social support with no significant impact on depressive symptoms.Clinical trial registration: Clincaltrials.gov NCT02444.
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Affiliation(s)
- Sara Mazzoni
- University of Albama at Birmingham, Birmingham, Alabama, USA
| | - Pamela Hill
- Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Ariel Briggs
- University of Colorado Hospital, Aurora, Colorado, USA
| | - Kate Barbier
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Alison Cahill
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - George Macones
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Graham Colditz
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Methodius Tuuli
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Ebony Carter
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
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Chirwa E, Kapito E, Jere DL, Kafulafula U, Chodzaza E, Chorwe-Sungani G, Gresh A, Liu L, Abrams ET, Klima CS, McCreary LL, Norr KF, Patil CL. An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi. BMC Public Health 2020; 20:205. [PMID: 32039721 PMCID: PMC7008527 DOI: 10.1186/s12889-020-8276-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes. METHODS Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. DISCUSSION This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.
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Affiliation(s)
- Ellen Chirwa
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Esnath Kapito
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Diana L Jere
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Ursula Kafulafula
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Elizabeth Chodzaza
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | | | - Ashley Gresh
- Johns Hopkins University, School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Li Liu
- University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street (M/C 932), Chicago, IL, 60612, USA
| | - Elizabeth T Abrams
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Carrie S Klima
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Linda L McCreary
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Kathleen F Norr
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Crystal L Patil
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA.
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Hetherington E, McDonald S, Williamson T, Tough S. Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:259-267. [PMID: 31256206 DOI: 10.1007/s00127-019-01740-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/24/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women's trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories. METHODS Data from the All Our Families longitudinal birth cohort was used to assess women's perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership. RESULTS Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low. CONCLUSION Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada.
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Walsh K, McCormack CA, Webster R, Pinto A, Lee S, Feng T, Krakovsky HS, O'Grady SM, Tycko B, Champagne FA, Werner EA, Liu G, Monk C. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc Natl Acad Sci U S A 2019; 116:23996-24005. [PMID: 31611411 PMCID: PMC6883837 DOI: 10.1073/pnas.1905890116] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.
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Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, The Bronx, NY 10461
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Clare A McCormack
- Center for Science and Society, Columbia University, New York, NY 10027
| | - Rachel Webster
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Anita Pinto
- Data Science, Columbia University, New York, NY 10027
| | - Seonjoo Lee
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Tianshu Feng
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - H Sloan Krakovsky
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Sinclaire M O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Benjamin Tycko
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, NJ 07110
| | - Frances A Champagne
- Department of Psychiatry, Columbia University, New York, NY 10032
- Department of Psychology, University of Texas at Austin, Austin, TX 78712
| | - Elizabeth A Werner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Grace Liu
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032;
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
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Martinez I, Kershaw TS, Keene D, Perez-Escamilla R, Lewis JB, Tobin JN, Ickovics JR. Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City. Ann Behav Med 2019; 52:42-52. [PMID: 28707175 DOI: 10.1007/s12160-017-9924-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Syndemics are co-occurring epidemics that synergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents. Purpose The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time. Methods In a cohort of 772 pregnant Latina adolescents (ages 14-21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time. Results We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = -0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = -0.1348, P ≤ 0.0001; β1stGen = -0.1932, P = 0.0005). Both immigrant generation (βImmigrant = -0.1125, P = 0.0035; β1stGen = -0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum. Conclusion Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy.
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Affiliation(s)
- Isabel Martinez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Danya Keene
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Jeannette R Ickovics
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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Andrade-Romo Z, Heredia-Pi IB, Fuentes-Rivera E, Alcalde-Rabanal J, Cacho LBB, Jurkiewicz L, Darney BG. Group prenatal care: effectiveness and challenges to implementation. Rev Saude Publica 2019; 53:85. [PMID: 31576945 PMCID: PMC6763281 DOI: 10.11606/s1518-8787.2019053001303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/07/2019] [Indexed: 11/13/2022] Open
Abstract
Group prenatal care is an alternative model of care during pregnancy, replacing standard individual prenatal care. The model has shown maternal benefits and has been implemented in different contexts. We conducted a narrative review of the literature in relation to its effectiveness, using databases such as PubMed, EBSCO, Science Direct, Wiley Online and Springer for the period 2002 to 2018. In addition, we discussed the challenges and solutions of its implementation based on our experience in Mexico. Group prenatal care may improve prenatal knowledge and use of family planning services in the postpartum period. The model has been implemented in more than 22 countries and there are challenges to its implementation related to both supply and demand. Supply-side challenges include staff, material resources and organizational issues; demand-side challenges include recruitment and retention of participants, adaptation of material, and perceived privacy. We highlight specific solutions that can be applied in diverse health systems.
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Affiliation(s)
- Zafiro Andrade-Romo
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Ileana B Heredia-Pi
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Evelyn Fuentes-Rivera
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Jacqueline Alcalde-Rabanal
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | | | - Laurie Jurkiewicz
- University of California San Francisco. San Francisco General Hospital. Department of ObGyn & Reproductive Sciences. San Francisco, CA, USA
| | - Blair G Darney
- Oregon Health & Science University. Department of Obstetrics & Gynecology. Portland, OR, USA
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Byrskog U, Ahrne M, Small R, Andersson E, Essen B, Adan A, Ahmed FH, Tesser K, Lidén Y, Israelsson M, Åhman-Berndtsson A, Schytt E. Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project. BMJ Open 2019; 9:e030314. [PMID: 31371301 PMCID: PMC6677950 DOI: 10.1136/bmjopen-2019-030314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes. OVERALL AIM To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study. METHODS AND ANALYSIS An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group. ETHICS AND DISSEMINATION The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.
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Affiliation(s)
- Ulrika Byrskog
- School of Education, Health and Social sciences, Dalarna University, Falun, Sweden
| | - Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rhonda Small
- Mother and Child Health Research, La Trobe University, Melbourne, Victoria, Australia
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Birgitta Essen
- Womens and Childrens Health, Uppsala University, Uppsala, Sweden
| | - Aisha Adan
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Fardosa Hassen Ahmed
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Karin Tesser
- Antenatal Care Clinic, Domnarvet, Borlänge, Sweden
| | | | | | | | - Erica Schytt
- Centre for Clinical Research Dalarna-Uppsala University, Falun, Sweden
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Brookfield J. Group antenatal care for Aboriginal and Torres Strait Islander women: An acceptability study. Women Birth 2019; 32:437-448. [PMID: 31326383 DOI: 10.1016/j.wombi.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.
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Affiliation(s)
- Jo Brookfield
- P.O. Box 53, Earlville, Queensland, 4870, Australia.
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Potter JE, Duthely LM, Diaz-Mendez N, Smith L, Messick BJ, Echenique M, Galli J, Yasin S, Villar-Loubet O. Implementing CenteringPregnancy Group Prenatal Care for Minority Women Living with HIV at an Urban University Hospital. J Midwifery Womens Health 2019; 64:451-461. [PMID: 31222899 DOI: 10.1111/jmwh.12987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pregnant women with HIV require sustained education and support throughout pregnancy to achieve healthy perinatal outcomes. To enhance prenatal care for women with HIV, the Prenatal Immunology Service at the University of Miami Miller School of Medicine adapted the Centering Healthcare Institute's CenteringPregnancy curriculum to include HIV content. Nurse-midwives introduced the curriculum in a pilot project to learn if women would enroll in group prenatal care. A retrospective record review was conducted to evaluate perinatal outcomes among women with HIV who received prenatal care in a group setting. METHODS Data were collected from the electronic health records of women with HIV who received either CenteringPregnancy-HIV group prenatal care or traditional prenatal care between March 2015 and July 2016. Sociodemographic factors, HIV immune markers, and pregnancy and birth outcomes were reviewed. Univariate and bivariate statistics and multiple regression models assessed differences between women in CenteringPregnancy-HIV group prenatal care compared with women with HIV in traditional care. RESULTS Among women with HIV who received prenatal care during the pilot project, 128 met eligibility criteria for review. Perinatal outcomes were analyzed for 117 women who had a live birth; of these, 14 participated in CenteringPregnancy-HIV group prenatal care, and 103 received traditional care. Demographic profiles were similar in both groups. No significant differences in perinatal outcomes were observed among women in CenteringPregnancy-HIV group prenatal care compared with women with HIV in traditional prenatal care. DISCUSSION Women with HIV can often feel stigmatized and isolated. Group prenatal care can foster patient engagement, self-management, and social support to improve adherence to antiretroviral and other health regimens that promote healthy outcomes for both woman and newborn. Although results of this pilot study were not statistically significant, they show that CenteringPregnancy-HIV group prenatal care may be an option for women with HIV, but the benefits need further exploration in larger studies.
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Affiliation(s)
- JoNell E Potter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Lunthita M Duthely
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Nelly Diaz-Mendez
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Lindsay Smith
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Barbara J Messick
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Maria Echenique
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Johnny Galli
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Salih Yasin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Olga Villar-Loubet
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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Madeira AD, Rangen CM, Avery MD. Design and Implementation of a Group Prenatal Care Model for Somali Women at a Low-Resource Health Clinic. Nurs Womens Health 2019; 23:224-233. [PMID: 31077639 DOI: 10.1016/j.nwh.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/17/2018] [Accepted: 03/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To design and implement group prenatal care (GPC) for Somali women and to evaluate participants' satisfaction, knowledge, and care engagement. DESIGN Quality improvement project. SETTING/LOCAL PROBLEM A federally qualified health center in an urban Midwestern setting, which serves a largely East African immigrant and refugee population. PARTICIPANTS Pregnant Somali women at more than 20 weeks gestation receiving prenatal care at the project site. Many participants were non-English speaking. INTERVENTION/MEASUREMENTS While honoring the 13 essential elements of CenteringPregnancy, the model was adapted to the East African population at the project site and offered to all eligible women receiving individual prenatal care at the clinic. Women attended biweekly sessions, including individual assessment and education, exposure to integrative health therapies, and group discussion. Pre- and postintervention data were collected in surveys and in-depth interviews from March through August 2017. RESULTS Seventeen Somali women attended a median of two sessions (range = 1-7). Self-reported results for knowledge of safe exercise in pregnancy (p = .02), exclusive breastfeeding (p = .04), what happens in the hospital (p = .02), and stress management (p = .03) increased after GPC participation. Ninety-three percent of women preferred GPC to individual care. CONCLUSION When adapted to meet the needs of Somali women, GPC has the potential to improve care satisfaction, increase knowledge, and reduce stress during pregnancy and the postpartum period. This model may interest women and care providers in similar community health care settings.
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Sangsawang B, Wacharasin C, Sangsawang N. Interventions for the prevention of postpartum depression in adolescent mothers: a systematic review. Arch Womens Ment Health 2019; 22:215-228. [PMID: 30116896 DOI: 10.1007/s00737-018-0901-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/08/2018] [Indexed: 01/08/2023]
Abstract
Postpartum depression (PPD) is a major public health problem affecting 10-57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.
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Affiliation(s)
- Bussara Sangsawang
- Department of Maternal-Child Nursing and Midwifery Nursing, Srinakharinwirot University, 63 M.7 Rangsit-Nakhonnayok Rd., Nakhonnayok, 26120, Thailand.
| | - Chintana Wacharasin
- Department of Pediatrics Nursing, Faculty of Nursing, Burapha University, Saen Suk, Chon Buri, Thailand
| | - Nucharee Sangsawang
- Department of Maternal-Child Nursing and Midwifery Nursing, Srinakharinwirot University, 63 M.7 Rangsit-Nakhonnayok Rd., Nakhonnayok, 26120, Thailand
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Adaji SE, Jimoh A, Bawa U, Ibrahim HI, Olorukooba AA, Adelaiye H, Garba C, Lukong A, Idris S, Shittu OS. Women's experience with group prenatal care in a rural community in northern Nigeria. Int J Gynaecol Obstet 2019; 145:164-169. [PMID: 30779108 DOI: 10.1002/ijgo.12788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/10/2018] [Accepted: 02/13/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess women's experience of group prenatal care in a rural Nigerian community. METHODS In an observational study, consenting pregnant women were enrolled in a group prenatal care program based on the CenteringPregnancy model from July 1, 2010, to June 30, 2011, in Tsibiri, Nigeria. Women were interviewed before joining the group and postnatally. A predesigned pro forma was used to assess group behavior during sessions. Descriptive and inferential statistics were applied to data. RESULTS In total, 161 women enrolled, and 54 of 72 scheduled prenatal sessions took place. The average number of visits was three per woman, with good group interaction and cohesion. Mothers who could mention at least five out of eight danger signs of pregnancy increased from 1.4% (2) to 13.3% (14) (P<0.001, 95% CI 4.28-19.52), while mean knowledge score for danger signs increased from 31% to 47.8% (P<0.001, 95% CI 0.86-2.16). Commitment to birth preparedness plans was impressive. The mothers enjoyed the group sessions and shared the lessons they learned with others. CONCLUSION Group prenatal care was feasible and acceptable to women in the present study setting. Comparative trials would be helpful to demonstrate the benefits of the tested model in low-income settings.
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Affiliation(s)
- Sunday E Adaji
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | - Adenike Jimoh
- College of Health Science, Bingham University, Jos, Nigeria
| | - Umma Bawa
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | - Habiba I Ibrahim
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Comfort Garba
- CBS Research Group, PRHI, Ahmadu Bello University, Zaria, Nigeria
| | - Anita Lukong
- Department of Nursing Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Suleiman Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Oladapo S Shittu
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
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Hackley B, Elyachar-Stahl E, Savage AK, Stange M, Hoffman A, Kavanaugh M, Aviles MM, Arévalo S, Machuca H, Shapiro A. A Qualitative Study of Women's Recall of Content and Skills Developed in Group Prenatal and Well-Baby Care 2 Years Later. J Midwifery Womens Health 2018; 64:209-216. [PMID: 30407720 DOI: 10.1111/jmwh.12899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Group prenatal and well-baby care is a system of health care visits that occur in a group setting. Each individual session lasts approximately 2 hours, allowing more time for education and support than can occur in an individual visit. Compared with individual care, research suggests that group care is associated with similar or better short-term outcomes, but no studies have yet examined potential long-term benefits beyond one year postpartum. The purpose of this qualitative descriptive study was to elicit women's recall about content covered in group prenatal and well-baby care and whether they were or were not continuing to use skills discussed during group prenatal and well-baby care 2 or more years after their group ended. METHODS Eligible women participated in group prenatal and/or well-baby care between 2008 and 2012, were aged at least 18 years, and were English-speaking. Of the 127 eligible women, 32 were reached and 17 agreed to participate. Women were interviewed on average 3 years after group prenatal or well-baby care ended using a semistructured interview guide. Transcripts were reviewed and coded by each team member. Final codes and themes were identified using an iterative review process among the research team. RESULTS Three themes were identified: sustained change, transferable skills, and group as a safe haven. All women were still using strategies discussed during group and had made sustained improvements in nutrition, stress management, and/or in the quality of their interactions with their children, partner, or families. The group environment was described as a safe haven: a respectful, nonjudgmental space that allowed women to share and support each other while learning new skills. DISCUSSION This is the first study to document that group prenatal and well-baby care is associated with long-term benefits in areas not yet reported in the literature: nutrition, family communication, and parenting.
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Chikalipo MC, Nyondo-Mipando L, Ngalande RC, Muheriwa SR, Kafulafula UK. Perceptions of pregnant adolescents on the antenatal care received at Ndirande Health Centre in Blantyre, Malawi. Malawi Med J 2018; 30:25-30. [PMID: 29868156 PMCID: PMC5974383 DOI: 10.4314/mmj.v30i1.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Rates of adolescent pregnancies in Malawi remain high at 29%. Early childbearing is a major health issue because of its increased risk for adverse pregnancy outcomes compared to older women. Although antenatal care is believed not to directly reduce maternal mortality, comprehensive antenatal care, especially in developing countries, may promote safe motherhood as actual and potential problems related to pregnancy are identified and treated in a timely manner. While antenatal services in Malawi are meant to provide antenatal care for adolescents, much of the care provided seems to be limited. The purpose of this study was to explore views of pregnant adolescent girls about the antenatal care they received at Ndirande clinic. Understanding adolescents' views about the care they receive may provide an opportunity to identify gaps in the care and ultimately improve the care for pregnant adolescent girls. Methods We conducted a cross-sectional exploratory study on pregnant adolescent girls' perceptions of the antenatal care received at Ndirande Health Centre in Blantyre, Malawi, from 7 to 28 October 2011. We interviewed 15 purposively selected pregnant adolescents aged 14 to 19 years using a semi-structured interview guide. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa into English. Data were analyzed using thematic content analysis. Findings Two major themes emerged from the findings: a) caring b) motivation for attending antenatal care. The findings indicate that pregnant adolescents view the establishment of a clinic as acceptable and feasible. However, the care was inadequate, as it did not meet the expected standards and the needs of the pregnant adolescents. Conclusion The antenatal care adolescent girls received at Ndirande clinic is inadequate as it does not meet their needs. Innovative models of care that embrace the principles of youth friendly services should be employed.
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Affiliation(s)
| | - Linda Nyondo-Mipando
- University of Malawi - School of Public Health and Family Medicine, College of Medicine
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Vulnerable Women’s Perceptions of Individual Versus Group Prenatal Care: Results of a Cross-Sectional Survey. Matern Child Health J 2018; 22:1632-1638. [DOI: 10.1007/s10995-018-2559-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rodriguez VJ, Matseke G, Cook R, Bellinger S, Weiss SM, Alcaide ML, Peltzer K, Patton D, Lopez M, Jones DL. Infant Development and Pre- and Post-partum Depression in Rural South African HIV-Infected Women. AIDS Behav 2018; 22:1766-1774. [PMID: 28986652 DOI: 10.1007/s10461-017-1925-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV-exposed infants born to depressed women may be at risk for adverse developmental outcomes. Half of HIV-infected women in rural South Africa (SA) may suffer from pregnancy-related depression. This pilot study examined the impact of depression in HIV-infected women in rural SA on infant development. Mother-infant dyads (N = 69) were recruited in rural SA. Demographics, HIV disclosure, depression, male involvement, and alcohol use at baseline (18.35 ± 5.47 weeks gestation) were assessed. Male involvement, depression, infant HIV serostatus and development were assessed 12 months postnatally. Half of the women (age = 29 ± 5) reported depression prenatally and one-third reported depression postnatally. In multivariable logistic regression, not cohabiting with their male partner, nondisclosure of HIV status, and postnatal depression predicted cognitive delay; decreased prenatal male involvement predicted delayed gross motor development (ps < 0.05). Assessing pregnancy-related depression among HIV-infected women and infant development and increasing male involvement may reduce negative developmental outcomes among HIV-exposed or infected infants.
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Thomas M, Hutchison M, Castro G, Nau M, Shumway M, Stotland N, Spielvogel A. Meeting Women Where They Are: Integration of Care As the Foundation of Treatment for At-Risk Pregnant and Postpartum Women. Matern Child Health J 2018; 21:452-457. [PMID: 28168590 DOI: 10.1007/s10995-016-2240-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose In these times of rapidly changing health care policies, those involved in the health care of women, especially during the reproductive years, have a unique and daunting opportunity. There is great potential to positively impact women's health through focus on prevention, attention to addressing disparities, and new focus on the integration of behavioral health care in primary care settings. Description In this report from the field, we suggest that the integration of mental health care into other health services and addressing underlying social needs by partnering with community-based organizations should be a top priority for all settings seeking to provide excellent health care for women. Assessment We describe our experience in a diverse, urban, safety net system to draw attention to four areas of innovation that others might adapt in their own systems: (1) addressing social support and other social determinants of health; (2) tailoring services to the specific needs of a population; (3) developing integrated and intensive cross-disciplinary services for high-risk pregnant women; and (4) bridging the divide between prenatal and postpartum care. Conclusion Women are more likely to be engaged with healthcare during their pregnancy. This engagement, however limited, may be a unique "window of opportunity" to help them address mental health concerns and implement positive behavior change. Future work should include research and program evaluation of innovative programs designed to serve the entire family and meeting at-risk women where they are.
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Affiliation(s)
- Melanie Thomas
- UCSF Department of Psychiatry, University of California, San Francisco, USA.
| | - Margaret Hutchison
- UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Gloria Castro
- UCSF Infant Parent Program, University of California, San Francisco, USA
| | - Melissa Nau
- UCSF Department of Psychiatry, University of California, San Francisco, USA
| | - Martha Shumway
- UCSF Department of Psychiatry, University of California, San Francisco, USA
| | - Naomi Stotland
- UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Anna Spielvogel
- UCSF Department of Psychiatry, University of California, San Francisco, USA
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Rosenthal L, Earnshaw VA, Moore JM, Ferguson DN, Lewis TT, Reid AE, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Intergenerational Consequences: Women's Experiences of Discrimination in Pregnancy Predict Infant Social-Emotional Development at 6 Months and 1 Year. J Dev Behav Pediatr 2018; 39:228-237. [PMID: 29176360 PMCID: PMC5866165 DOI: 10.1097/dbp.0000000000000529] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Racial/ethnic and socioeconomic disparities in infant development in the United States have lifelong consequences. Discrimination predicts poorer health and academic outcomes. This study explored for the first time intergenerational consequences of women's experiences of discrimination reported during pregnancy for their infants' social-emotional development in the first year of life. METHODS Data come from a longitudinal study with predominantly Black and Latina, socioeconomically disadvantaged, urban young women (N = 704, Mage = 18.53) across pregnancy through 1 year postpartum. Women were recruited from community hospitals and health centers in a Northeastern US city. Linear regression analyses examined whether women's experiences of everyday discrimination reported during pregnancy predicted social-emotional development outcomes among their infants at 6 months and 1 year of age, controlling for potentially confounding medical and sociodemographic factors. Path analyses tested if pregnancy distress, anxiety, or depressive symptoms mediated significant associations. RESULTS Everyday discrimination reported during pregnancy prospectively predicted greater inhibition/separation problems and greater negative emotionality, but did not predict attention skills or positive emotionality, at 6 months and 1 year. Depressive symptoms mediated the association of discrimination with negative emotionality at 6 months, and pregnancy distress, anxiety, and depressive symptoms mediated the association of discrimination with negative emotionality at 1 year. CONCLUSION Findings support that there are intergenerational consequences of discrimination, extending past findings to infant social-emotional development outcomes in the first year of life. It may be important to address discrimination before and during pregnancy and enhance support to mothers and infants exposed to discrimination to promote health equity across the life span.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jonathan N. Tobin
- Clinical Directors Network, New York, New York
- The Rockefeller University Center for Clinical and Translational Science, New York, New York
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