196: The impact of centeringpregnancy group prenatal care on preterm birth

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points

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The French implementation study PARENTHESE to improve prenatal care of immigrant women

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1069 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Azria ◽

F Eboue ◽

M Fallon ◽

O Khomry ◽

P Sauvegrain ◽

...

Keyword(s):

Pilot Study ◽

Prenatal Care ◽

Immigrant Women ◽

Group Model ◽

Group Prenatal Care ◽

Migrant Women ◽

Optimal Care ◽

Mortality And Morbidity ◽

Increased Risk ◽

The Impact

Abstract Numerous studies have shown that non-Western immigrant women have higher maternal and perinatal mortality and morbidity than women and children from host countries. This increased risk is partly explained by less access to quality antenatal care and more sub-optimal care. The organisation and provision of prenatal care in France remain unchanged on a model that is not very sensitive and adaptable to the specific needs of certain groups such as non-Western migrant women. Group prenatal care, an alternative and innovative model, can theoretically be rigorously implemented within the framework of the recommendations for prenatal care set by the French Haute Autorité de Santé and thus meet the objectives assigned to it. This alternative method of monitoring, implemented in different US settings, seems to increase access and adherence to prenatal monitoring, as well as women's involvement in its monitoring. Some studies also suggest that this type of prenatal monitoring could also reduce maternal and perinatal risk. Such intervention has never been tested in France and moving away from a prenatal monitoring model based on individual monitoring towards a group model requires overcoming significant cultural barriers. Before being able to test the impact of a complex intervention such as group prenatal care for migrant women and wider deployment, we set up a pilot study with the aim of precisely defining the intervention and preparing and documenting its implementation process in three different sites using qualitative and quantitative approaches. It is also to evaluate its acceptability for women who participate in these groups as well as for professionals. In addition to presenting this pilot study at this workshop, the objective of this presentation is also to highlight the importance of contextual considerations in the design of the intervention or its implementation in the particular context of intervention aimed at improving migrant populations' health.

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