Patient and provider perspectives on preterm birth risk assessment and communication

Tesfalul, Martha; Feuer, Sky K.; Castillo, Esperanza; Coleman‐Phox, Kimberly; O'Leary, Allison; Kuppermann, Miriam

doi:10.1016/j.pec.2021.03.038

Cited by 4 publications

(3 citation statements)

References 49 publications

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“…It is possible that some practitioners using an electronic medical record template added an LDASA recommendation to patients’ medical records without ever engaging in a conversation with the patients about their LDASA eligibility. It can be challenging for practitioners to adequately communicate risk information to patients, particularly regarding complex, uncertain, or unfamiliar issues . Moreover, pregnant patients may feel wary of medication use, especially when the benefits are unclear to them.…”

Section: Discussionmentioning

confidence: 99%

“…It can be challenging for practitioners to adequately communicate risk information to patients, particularly regarding complex, uncertain, or unfamiliar issues. 26,27 Moreover, pregnant patients may feel wary of medication use, especially when the benefits are unclear to them. As a result, even if a conversation with a patient about LDASA eligibility occurs, it is possible that the conversation and any plan-of-care materials offered may not provide the information in a way that allows the patient to make a fully informed decision.…”

Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 99%

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Use of a Smartphone App to Explore Potential Underuse of Prophylactic Aspirin for Preeclampsia

Krishnamurti

Davis

Rodriguez³

et al. 2021

JAMA Netw Open

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IMPORTANCE Preeclampsia is a leading preventable cause of maternal morbidity and mortality.Initiation of low-dose aspirin (LDASA) treatment at or before 16 weeks' gestation may prevent preeclampsia onset for patients with specific risk factors. OBJECTIVE To assess potential underuse of LDASA and reasons for underuse using data from a prenatal care smartphone app. DESIGN, SETTING, AND PARTICIPANTSIn this prospective cohort study, English-speaking pregnant patients aged 18 years or older from the UPMC health care system received an invitation to use the MyHealthyPregnancy app at their first prenatal appointment. Use of the app was voluntary.The study took place between September 23, 2019, and August 31, 2020, as part of a qualityimprovement initiative.EXPOSURES The app offered educational information, monitoring tools, and routine screenings tailored to patient-entered gestational age and demographic and clinical characteristics. App-based questions included LDASA eligibility based on US Preventive Services Task Force criteria for preeclampsia risk and a monthly prompt about LDASA recommendations from the patient's health care practitioner. MAIN OUTCOMES AND MEASURESThe primary outcomes were the receipt of LDASA recommendations from a practitioner and adherence to any such recommendation, as self-reported on the app. Patients' medical records were examined to cross-reference their self-reports of an LDASA recommendation. Multivariable logistic regression was used to model patient-perceived recommendation as a function of factors associated with preeclampsia. RESULTSThe patient cohort consisted of 2563 patient participants (2036 [79%] White; mean [SD] age, 30 [5.2] years) with 2567 pregnancies; 1882 pregnancies (73.3%) were among women with private or employer-based insurance, and 1246 (48.5%) were among nulliparous patients. At least 1 factor associated with high risk for preeclampsia was reported in 316 pregnancies (12.3%), and 2 or more factors associated with moderate risk were reported in 1051 (40.9%). Of the 1015 pregnancies for which patients answered voluntary questions about aspirin use, 124 (12.2%) met at least 1 criterion for highest risk of preeclampsia. In 57 (46.0%) of these pregnancies, the patient indicated that their practitioner recommended LDASA; after examination of the medical records, 90 pregnancies (72.6%) had evidence of an LDASA recommendation and 34 (27.4%) did not. Of the 90 pregnancies with a documented LDASA recommendation, 33 patients (36.7%) were unaware of it.Prior preeclampsia (28 weeks' gestation: odds ratio, 20.1; 95% CI, 11.0-36.9) and chronic hypertension (28 weeks' gestation: odds ratio, 17.4; 95% CI, 6.3-48.2) were the primary high-risk factors associated with recommendation of LDASA. (continued) Key Points Question Can potential underuse of prophylactic low-dose aspirin (LDASA) and reasons for underuse be ascertained using data from a prenatal care smartphone app in a qualityimprovement setting? Findings In this cohort study of 2567 pregnancies among 2563 women in a single ...

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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 99%

Use of a Smartphone App to Explore Potential Underuse of Prophylactic Aspirin for Preeclampsia

Krishnamurti

Davis

Rodriguez³

et al. 2021

JAMA Netw Open

View full text Add to dashboard Cite

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“… 9 Research highlights a misalignment in knowledge of preterm birth between parents and clinicians; despite many parents noting a desire to have had prior conversations about preterm birth, clinicians disclose the outcomes of preterm birth only selectively, citing fear of negative reaction as one of numerous reasons to withhold information. 10 It is vital that more is understood about both maternal experiences of preterm birth and maternal understanding about outcomes following preterm birth. Given the intertwined nature of preterm birth and parental experience, further understanding is not only warranted but vital when considering suggestions to improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

Qualitative interview with mothers of moderately or late preterm infants in the UK: where are the care gaps?

Laverty,

Surtees,

Sutherland

et al. 2024

BMJ Open

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IntroductionPreterm birth (<37 gestational weeks) accounts for an increasing proportion of global births each year, with moderately or late preterm birth (MLPT) (32+0/7–36+6/7gestational weeks) comprising over 80% of all preterm births. Despite the frequency, MLPT births represent only a small fraction of prematurity research, with research exploring the parental experiences of having a child born MLPT particularly neglected. It is vital this perspective is considered to provide appropriate grounding for future research and service provision.MethodsSix mothers from the UK of infants (aged between 18 and 36 months) born MLPT were invited to take part in a semistructured qualitative interview study. Reflexive thematic analysis was employed to explore the data and codes were then conceptualised through a process of inductive reasoning to identify patterns of meaning.ResultsFive themes are presented that are conceptualised from the data: (1) the moderate or later preterm ‘label—does it matter?, (2) vulnerability within a new role, (3) coming home and wanting to start ‘normal’ life, (4) comparisons to provide a reference to experiences and (5) experience of professionals throughout the pregnancy, newborn and early years journey.ConclusionsFindings offer in-depth evidence surrounding mothers’ experiences of healthcare throughout pregnancy and immediately after birth, perceptions of the ‘preterm’ label and thoughts on how mothers reflect on their experiences. Future research should show an awareness of the broader family context when interpreting findings and providing suggestions for future research avenues or service provision.

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Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California

Jelliffe-Pawlowski,

Baer,

Oltman

et al. 2024

JAMA Netw Open

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ImportancePreterm birth (PTB) (gestational age &lt;37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities.ObjectiveTo describe the association of PTB rates with inequities as well as related risk and protective factors over the past decade in a US population–based cohort.Design, Setting, and ParticipantsThis retrospective cohort study of singleton live births in California from January 1, 2011, to December 31, 2022, was conducted using vital statistics records and hospital records. The cohort included births with a gestational age of 22 to 44 weeks.Main Outcomes and MeasuresPreterm birth rates by racial and ethnic group and by public and nonpublic insurance (considered as a proxy for socioeconomic status) were studied across years. Log-linear regression (relative risks with 95% CIs) was used to evaluate risk and protective factors within groups. Associations of PTB rates with risk and protective factors were assessed.ResultsThis study included 5 431 018 singleton live births to individuals who identified as American Indian or Alaska Native (0.3%), Asian (14.2%), Black (4.9%), Hispanic (47.8%), or White (27.0%). A total of 43.1% of births were to individuals with public health insurance. From 2011 to 2022, the overall PTB rate increased from 6.8% to 7.5% (change [SE], 10.6% [0.6%]; z score of 18.5; P &lt; .001). Differences in PTB rates and associated changes were observed for racial and ethnic groups and insurance groups. For example, 2022 PTB rates ranged from 5.8% among White individuals with nonpublic insurance to 11.3% among Black individuals with public health insurance. From 2011 to 2022, PTB rates decreased from 9.1% to 8.8% (change [SE], −3.5% [4.2]; z score of −0.8; P = .42) among Black individuals with nonpublic insurance, whereas they increased from 6.4% to 9.5% (change [SE], 49.8% [16.0%]; z score of 3.1; P = .002) among American Indian or Alaska Native individuals with nonpublic insurance. Increases in some risk factors (eg, preexisting diabetes, sexually transmitted infections, mental health conditions) were observed in most groups, and decreases in some protective factors (eg, participation in the California Women, Infants, and Children program) (P for trend &lt; .001 from 2011 to 2021) were observed mostly in low-income groups.Conclusions and RelevanceIn this cohort study of singleton live births in California, PTB rates increased in many groups. Persistent racial and ethnic and socioeconomic inequities were also observed. Changes in risk and protective factors provided clues to patterns of PTB. These data point to an urgent need to address factors associated with PTB at both the individual and population levels.

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Patient and provider perspectives on preterm birth risk assessment and communication

Cited by 4 publications

References 49 publications

Use of a Smartphone App to Explore Potential Underuse of Prophylactic Aspirin for Preeclampsia

Use of a Smartphone App to Explore Potential Underuse of Prophylactic Aspirin for Preeclampsia

Qualitative interview with mothers of moderately or late preterm infants in the UK: where are the care gaps?

Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California

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