(247) The association of group prenatal care and pregnancy outcomes among high stress pregnant individuals

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Chronic stress is associated with adverse pregnancy outcomes. We examined whether high stress participants in group prenatal care (GPNC) had lower risk of preterm birth (PTB) and small for gestational age birth (SGA) 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) using validated surveys by summing the number of positive surveys, defined by clinical cutoffs 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 ≥ the median number of visits (PC). PTB < 37 weeks and SGA less than the 10^th %ile were abstracted from the medical record. Associations of stress, PTB, and SGA were tested using logistic regression.

Results: Of the 1013 PIINC 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 274/1013 (27%) of the mITT cohort and 170/660 (26%) of the PC cohort were “high stress”. High stress individuals were not more likely to deliver SGA or PTB (PTB uOR 1.03 (0.61 - 1.71); SGA uOR 0.85 (0.55 - 1.32)). PTB rates were similar for high stress participants in both GPNC and IPNC (mITT 8.4% versus 7.5%; PC 3.2% versus 3.9%). SGA rates were lower for high stress participants assigned to GPNC versus IPNC in both the mITT and the PC cohorts (mITT 8.3% versus 13%; PC 5.2% versus 11.8%), though the difference was not statistically significant (Table 2).

Conclusion: High stress individuals in GPNC did not have significantly better pregnancy outcomes than those in IPNC. We observed lower incidences of SGA in the GPNC groups, and lower incidences of PTB and SGA among high stress participants who attended ≥ the median number of GPNC visits. Future research should examine interventions targeted at high stress pregnancies.

Primary & Presenting Author(s)

Lauren S. Keenan-Devlin, MPH, PhD
Research Scientist
NorthShore University HealthSystem
Evanston, Illinois, United States

Coauthor(s)

LS
Lavisha Singh, MS
NorthShore University HealthSystem
Evanston, Illinois, United States
GM
Greg E. Miller, MPH, PhD
Northwestern University
Evanston, Illinois, United States
LE
Linda M. Ernst, MD
NorthShore University Health System
Evanston, Illinois, United States
Jessica Britt, BS, PhD
Prisma Health
Greenville, South Carolina, United States
Britney P. Smart, MPH
Research Manager
NorthShore University Health System
Evanston, Illinois, United States
Alexa A. Freedman, PhD (she/her/hers)
NorthShore University HealthSystem
Evanston, Illinois, United States
AC
Amy Crockett, MD, MSPH
Greenville Health System
Greenville, South Carolina, United States
Ann Borders, MD, MPH, MSc (she/her/hers)
Clinical Associate Professor, Executive Director ILPQC
NorthShore University HealthSystem, Evanston Hospital
Evanston, Illinois, United States