(805) The association of group prenatal care and inflammation among pregnant individuals reporting high stress

Chronic stress is associated with inflammation in pregnancy. We examined whether high stress participants in group prenatal care (GPNC) had lower systemic and placental chronic inflammation compared to those in individual care (IPNC).

Study Design: the Cradle RCT enrolled 2146 participants in Greenville SC from 2016-2020, and 56% of those participants enrolled in the PIINC sub-study. We created a novel stress score (range 0-6) totaling the number of validated surveys positive for food insecurity, ACES, housing instability, and neighborhood safety, and top quartile for discrimination and life stressors. Those scoring ≥3 were considered “high stress”. Exposure to GPNC or IPNC was measured as completing ≥1 visit of assigned treatment (mITT), or ≥ median number of visits (PC). CRP, IL10, IL1ra, IL6, and TNFα were measured in maternal serum collected between 12’0 to 20’6 and 32’0 to 41’0 weeks and z-scored, and placental chronic inflammatory lesions were identified via histology. Linear and logistic regressions tested associations between treatment and inflammation.

Results: Of the 1013 participants, 36% were Black, 23% were Hispanic, 40% were white, and 96% were enrolled in Medicaid. 75% of the sample had ≥1 positive survey, and 274 (27%) of the mITT cohort and 170 (26%) of the PC cohort were “high stress”. GPNC participants had higher systemic inflammation compared to IPNC participants (mITT: β=0.51 (95%CI 0.02, 1.00)), but high stress participants in both GPNC and IPNC had similar systemic inflammatory scores (mITT: -0.1 (-1.9, 2.1) for GPNC; -0.8 (-2.2, 1.6) for IPNC) and similar prevalence of placental chronic inflammatory lesions (mITT: 51.3% GPNC; 50.0% IPNC). Low-stress participants in GPNC had a larger increase in systemic inflammation from 2^nd to 3^rd trimester compared to those in IPNC; we did not see this difference in high-stress participants.

Conclusion: High stress individuals in GPNC did not have significantly different systemic or chronic placental inflammation compared to those in IPNC. Future research should examine interventions to improve outcomes for high stress pregnancies.