Birth outcomes for medically high-risk pregnancies: comparing group to individual prenatal care

2021 ◽  
Author(s):  
Emily Heberlein ◽  
Jessica C. Smith ◽  
Ana LaBoy ◽  
Jessica Britt ◽  
Amy Crockett
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Prenatal Care ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Outcome Data ◽  
Exposure Level ◽  
Group Prenatal Care ◽  
Minimum Threshold ◽  
Individual Care

Objective(s): Group prenatal care models were initially designed for women with medically low risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birthweight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group vs. individual prenatal care. Study Design: This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI >45). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (1 or more groups) or minimum threshold (≥ 5 groups). Results: Participation in group prenatal care at either treatment exposure level was associated with a lower risk of NICU admissions (10.2% group vs 13.8% individual care, OR 0.708, p<0.001). Participating in the minimum threshold of groups (≥5 sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR 0.569, p<0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR 0.483, p<0.001). No differences in birthweight were observed. Conclusion: This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birthweight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups.

scholarly journals Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshua P. Mersky ◽  
ChienTi Plummer Lee
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Low Income ◽  
Adverse Childhood Experiences ◽  
Pregnancy Loss ◽  
Low Birthweight ◽  
Childhood Adversity ◽  
Risk Models ◽  
Childhood Experiences ◽  
Adverse Childhood

Abstract Background Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women’s birth outcomes. Methods We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant’s reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education. Results Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08–1.17), preterm birth (OR = 1.07; 95% CI = 1.01–1.12), and low birthweight (OR = 1.08; 95% CI = 1.03–1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern. Conclusions Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

The Effects of Prenatal Care on Birth Outcomes: Reconciling a Messy Literature

2019 ◽  
Author(s):  
Hope Corman ◽  
Dhaval Dave ◽  
Nancy E. Reichman
Keyword(s):  
Prenatal Care ◽  
Social Services ◽  
Support Groups ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Population Level ◽  
Spillover Effects ◽  
The United States ◽  
Long Term Effects

Prenatal care, one of the most frequently used forms of healthcare in the United States, involves a series of encounters during the gestational period, educates women about pregnancy, monitors existing medical conditions, tests for gestational health conditions, and refers expectant mothers to services such as support groups and social services. However, an increasingly methodologically rigorous literature suggests that the effects of prenatal care timing and quantity on birth outcomes, particularly low birthweight, are modest at the population level. A review and synthesis of the literature suggests that the questions typically being asked may be too narrow and that more attention should be paid to the characterization of infant health, characterization of the content and quality of prenatal care, potential heterogeneous effects, potential indirect effects on health behaviors that may benefit offspring, potential long-term effects, potential spillover effects (i.e., on mothers and their subsequent children), effects of preconceptional and lifetime care, and intergenerational effects.

Effects of a Multi-site Expansion of Group Prenatal Care on Birth Outcomes

2019 ◽  
Vol 23 (10) ◽  
pp. 1424-1433 ◽  
Author(s):  
Amy H. Crockett ◽  
Emily C. Heberlein ◽  
Jessica C. Smith ◽  
Pelin Ozluk ◽  
Sarah Covington-Kolb ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Birth Outcomes ◽  
Group Prenatal Care

scholarly journals Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study

2020 ◽  
Vol 17 (12) ◽  
pp. 4444
Author(s):  
Anisma R. Gokoel ◽  
Wilco C. W. R. Zijlmans ◽  
Hannah H. Covert ◽  
Firoz Abdoel Wahid ◽  
Arti Shankar ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Prenatal Exposure ◽  
Perceived Stress ◽  
Apgar Score ◽  
Low Birthweight ◽  
Depression Scale ◽  
Study Cohort ◽  
Adverse Birth Outcomes ◽  
Probable Depression

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 μg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen’s Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05–5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03–46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

Pilot Randomized Controlled Trial of Diabetes Group Prenatal Care

2020 ◽  
Author(s):  
Ebony B. Carter ◽  
Kate Barbier ◽  
Pamela K. Hill ◽  
Alison G. Cahill ◽  
Graham A. Colditz ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Self Care ◽  
Group Care ◽  
Group Prenatal Care ◽  
Diabetes Group ◽  
Randomized Controlled ◽  
Individual Care ◽  
Pilot Randomized Controlled Trial

Objective This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities. Study Design A pilot randomized controlled trial was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of gestational age at first study visit, ability to attend group care at specified times, and willingness to be randomized. Exclusion criteria included type 1 diabetes, multiple gestation, major fetal anomaly, serious medical comorbidity, and serious psychiatric illness. Women were randomized to Diabetes Group Prenatal Care or individual prenatal care. The primary outcome was completion of diabetes self-care activities, including diet, exercise, blood sugar testing, and medication adherence. Secondary outcomes included antenatal care characteristics, and maternal, neonatal, and diabetes management outcomes. Analysis followed the intention-to-treat principle. Results Of 159 eligible women, 84 (53%) consented to participate in the study and were randomized to group (n = 42) or individual (n = 42) prenatal care. Demographic characteristics were similar between study arms. Completion of diabetes self-care activities was similar overall, but women in group care ate the recommended amount of fruits and vegetables on more days per week (5.1 days/week ± 2.0 standard deviation [SD] in group care vs. 3.4 days ± 2.6 SD in individual care; p < 0.01) and gained less weight per week during the study period (0.2 lbs/week [interquartile range: 0–0.7] vs. 0.5 lbs/week [interquartile range: 0.2–0.9]; p = 0.03) than women in individual care. Women with gestational diabetes randomized to group care were 3.5 times more likely to have postpartum glucose tolerance testing than those in individual care (70 vs. 21%; relative risk: 3.5; 95% confidence interval: 1.4–8.8). Other maternal, neonatal, and pregnancy outcomes were similar between study arms. Conclusion Diabetes group care is feasible and shows promise for decreasing gestational weight gain, improving diet, and increasing postpartum diabetes testing among women with pregnancies complicated by diabetes. Key Points

Population Changes, Racial/Ethnic Disparities, and Birth Outcomes in Louisiana After Hurricane Katrina

2010 ◽  
Vol 4 (S1) ◽  
pp. S39-S45 ◽  
Author(s):  
Emily W. Harville ◽  
Tri Tran ◽  
Xu Xiong ◽  
Pierre Buekens
Keyword(s):  
Preterm Birth ◽  
Prenatal Care ◽  
Cesarean Section ◽  
Racial Disparities ◽  
New Orleans ◽  
Birth Outcomes ◽  
The State ◽  
Obstetric Outcomes ◽  
Population Changes ◽  
Inadequate Prenatal Care

ABSTRACTObjective: To examine how the demographic and other population changes affected birth and obstetric outcomes in Louisiana, and the effect of the hurricane on racial disparities in these outcomes.Methods: Vital statistics data were used to compare the incidence of low birth weight (LBW) (<2500 g), preterm birth (PTB) (37 weeks' gestation), cesarean section, and inadequate prenatal care (as measured by the Kotelchuck index), in the 2 years after Katrina compared to the 2 years before, for the state as a whole, region 1 (the area around New Orleans), and Orleans Parish (New Orleans). Logistic models were used to adjust for covariates.Results: After adjustment, rates of LBW rose for the state, but preterm birth did not. In region 1 and Orleans Parish, rates of LBW and PTB remained constant or fell. These patterns were all strongest in African American women. Rates of cesarean section and inadequate prenatal care rose. Racial disparities in birth outcomes remained constant or were reduced.Conclusions: Although risk of LBW/PTB remained higher in African Americans, the storm does not appear to have exacerbated health disparities, nor did population shifts explain the changes in birth and obstetric outcomes.(Disaster Med Public Health Preparedness. 2010;4:S39-S45)

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

2018 ◽  
Vol 218 (1) ◽  
pp. S130-S131
Author(s):  
Misty L. McDowell ◽  
Chelsea Abshire ◽  
Amy H. Crockett ◽  
Nancy L. Fleischer
Keyword(s):  
Preterm Birth ◽  
Prenatal Care ◽  
Group Prenatal Care ◽  
The Impact

scholarly journals Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

2020 ◽  
Vol 3 ◽  
pp. 1657
Author(s):  
Jay J. H. Park ◽  
Ofir Harari ◽  
Ellie Siden ◽  
Michael Zoratti ◽  
Louis Dron ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Adverse Birth Outcomes ◽  
Middle Income ◽  
Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

scholarly journals 1096. Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S328-S329
Author(s):  
Kira Newman ◽  
Katie Gustafson ◽  
Janet Englund ◽  
Joanne Katz ◽  
Amalia Magaret ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Medical Care ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Published Data ◽  
Adverse Birth Outcomes ◽  
South Asian Population ◽  
Adjusted Risk ◽  
Diarrheal Illness

Abstract Background Adverse birth outcomes, including low birthweight (LBW), small-for-gestational-age (SGA) and preterm birth, contribute to 60–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes. Methods We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011 to 2014. Illness episodes were defined as at least three watery bowel movements per day for one or more days with 7 diarrhea-free days between episodes. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. The c2 test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes. Results Of 3,682 women in the study, 527 (14.3%) experienced one or more episodes of diarrhea during pregnancy. Diarrhea incidence was not seasonal. Women with diarrhea had a median of one episode of diarrhea (interquartile range (IQR) 1–2 episodes) and two cumulative days of diarrhea (IQR 1–3 days). Of women with diarrhea, 16.1% (85) sought medical care. Mean maternal age, parity, biomass cook stove use, home latrine, water source, caste, and smoking did not differ in pregnant women with and without diarrhea. In crude and adjusted analyses, women with diarrhea during pregnancy were significantly more likely to have SGA infants (42.6% vs. 36.8%; adjusted risk ratio=1.20, 95% CI 1.06–1.36, P = 0.005). LBW and preterm birth incidence did not significantly differ between women with diarrhea during pregnancy and those without. There was no significant association between seeking medical care for diarrhea and birth outcomes. Conclusion Diarrheal illness during pregnancy was associated with a significantly higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings. Disclosures All authors: No reported disclosures.

Assisted reproductive technologies and birth outcomes: overview of recent systematic reviews

2005 ◽  
Vol 17 (3) ◽  
pp. 329 ◽  
Author(s):  
Carol Bower ◽  
Michèle Hansen
Keyword(s):  
Preterm Birth ◽  
Perinatal Mortality ◽  
Birth Outcomes ◽  
Birth Defects ◽  
Systematic Reviews ◽  
Low Birthweight ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Sound Studies

Several systematic reviews have been published recently on birth outcomes of infants conceived through assisted reproductive technologies (ART), compared with infants conceived spontaneously. These outcomes include perinatal mortality, preterm birth, low birthweight and birth defects. Methodological limitations of many of the individual studies (including small sample size, potential for bias in ascertainment of outcomes and considering singletons and multiples together) were obviated in these reviews by excluding studies where methods were considered inadequate, by conducting meta-analyses using data from all methodologically sound studies (small and large) and by examining singletons separately. Overall, the reviews indicate few differences between outcomes in ART twins compared with twins conceived spontaneously. However, in singleton ART infants, there are around two-fold increases in risk of perinatal mortality, low birthweight and preterm birth, about a 50% increase in small for gestational age and a 30–35% increase in birth defects, compared with singletons conceived spontaneously. Couples considering ART should be counselled about the increased risk of adverse outcomes. Epidemiologists, in conjunction with clinical and laboratory colleagues, should now focus on large, methodologically sound studies with long-term follow up that seek to identify the reasons for these increased risks and their long-term consequences, whether they are associated with particular technologies and causes of infertility, and how they might be reduced.

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