A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum

Handler, Arden; Johnson, Kay

doi:10.1007/s10995-016-2187-6

Cited by 13 publications

(14 citation statements)

References 89 publications

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“…Studies in the provinces of Manitoba and Newfoundland have shown that participation in prenatal support programs may improve birth outcomes [ 24 , 25 , 65 ]. Handler and Johnson [ 66 ] refer to prenatal care as “a critical anchor of the reproductive/perinatal health continuum for women who do become pregnant, often providing a woman’s first encounter with the health care delivery system” (p. 2221) The factors associated with inadequate prenatal care in this study offer some direction for improving use of prenatal care through strategies such as reduction of teenage pregnancy, optimal birth spacing, cessation of smoking and drug abuse, provision of social support, and providing an income supplement during pregnancy such as the Manitoba Prenatal Benefit [ 25 ]. Other authors have recommended paying special attention to socially vulnerable women to reduce variations in use of prenatal care [ 39 , 67 ] or more systematic attention to the roles of social disadvantage [ 68 ], and using a multidisciplinary approach [ 69 ].…”

Section: Discussionmentioning

confidence: 99%

Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba

Heaman

Martens

Brownell

et al. 2018

BMC Pregnancy Childbirth

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BackgroundEnsuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care.MethodsWe studied women giving birth in Manitoba from 2004/05–2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information.ResultsOverall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use.ConclusionThe rate of inadequate prenatal care in Manitoba ranged from 10.5–12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.

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Section: Discussionmentioning

confidence: 99%

Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba

Heaman

Martens

Brownell

et al. 2018

BMC Pregnancy Childbirth

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“…Moreover, gross disparities in these and other reproductive health outcomes are grounds for “evidence-based outrage” [70]. National initiatives to tackle disparities and rising rates of maternal morbidity and mortality [71–73] make a renewed focus on prenatal care access, structure, content and quality not only timely, but essential [74]. …”

Section: Discussionmentioning

confidence: 99%

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes

Cunningham¹,

Lewis²,

Thomas³

et al. 2017

BMC Pregnancy Childbirth

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BackgroundDespite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally.Methods/Design Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses.DiscussionBy bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the “triple aim:” better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model.Trial registrationClinicalTrials.gov, NCT02169024. Retrospectively registered on June 18, 2014.

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“…5 Although AA women are nearly twice as likely to suffer from pregnancy complications and multiple comorbidities, they are less apt to use health care after delivery than white women. 1,2 Further, at 40 deaths per 100,000 live births, the maternal mortality rate for AA women is 2 to 3 times greater than that for all other racial or ethnic groups. 5,6 Poor PNC utilization may be a factor associated with poorer maternal health outcomes, including the aforementioned.…”

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confidence: 97%

“…renatal care (PNC) remains a critical anchor in the continuum of women's health care given that nearly 3 of every 4 women will give birth at least 1 time in their lifetime. 1 For many women, PNC represents their first encounter with the healthcare system since childhood. 1 As such, PNC presents the opportunity for healthcare providers to offer health education 1−3 and identify or monitor underlying chronic medical conditions and pregnancy complications.…”

mentioning

confidence: 99%

“…1 For many women, PNC represents their first encounter with the healthcare system since childhood. 1 As such, PNC presents the opportunity for healthcare providers to offer health education 1−3 and identify or monitor underlying chronic medical conditions and pregnancy complications. 2,4 Unfortunately, utilization of PNC by African-American (AA) women, in general, tends to be lower than that by white women.…”

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confidence: 99%

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Skin Tone Matters: Racial Microaggressions and Delayed Prenatal Care

Slaughter-Acey

Sneed

Parker

et al. 2019

American Journal of Preventive Medicine

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Introduction: Literature posits that discrimination can be a barrier to racial and ethnic minorities' healthcare use. This study examines the relationship between perceived discrimination in the form of racial microaggressions and delayed prenatal care in African American women. It also investigates whether this relationship is modified by women's shade of skin color owing to societal attitudes and beliefs tied to colorism (also known as skin-tone bias). Methods: Data were collected from a cohort of 1,410 black, African American women in metropolitan Detroit, Michigan, enrolled in 2009−2011 (analyzed between August 2017 and July 2018). Perceived racial microaggressions were assessed using the 20-item Daily Life Experiences of Racism and Bother scale. Logistic regression modeled the relationship between the Daily Life Experiences of Racism and Bother scale and delayed prenatal care, defined as third trimester or no prenatal care entry. Results: Nearly a quarter (24.8%) of women had delayed prenatal care. Logistic regression models showed that a Daily Life Experiences of Racism and Bother score above the median was associated with delayed prenatal care (AOR=1.31, 95% CI=1.00, 1.71). This association was moderated by selfreported maternal skin tone (interaction p=0.03). A higher Daily Life Experiences of Racism and Bother score was associated with delayed prenatal care among African-American women at either end of the color continuum (light brown: AOR=1.64, 95% CI=1.02, 2.65; dark brown: AOR=2.30, 95% CI=1.20, 4.41) but not in the middle (medium brown women). Conclusions: Skin tone−based mistreatment in tandem with racial discrimination in the form of racial microaggressions may influence African American women's use of prenatal care. These findings have implications related to the engagement of women of color, particularly African American women, in healthcare systems and maternal and child health programs.

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A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum

Cited by 13 publications

References 89 publications

Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba

Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes

Skin Tone Matters: Racial Microaggressions and Delayed Prenatal Care

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