Improving Peripartum Care Engagement Among Black Women at Risk for Low Prenatal Care Attendance: A Secondary Analysis of Predictors of Attendance and Sample Representativeness
Publication: Journal of Women's Health
Volume 31, Issue Number 10
Abstract
Background: The United States has unacceptably high rates of maternal and infant mortality, especially among Black women and their infants. Prenatal and postpartum care help reduce maternal and infant morbidity and mortality; however, Black women are less likely to access and utilize peripartum care largely due to structural racism. Identifying factors that buffer against the systemic barriers disproportionately impacting this community is an important step in addressing racial health disparities. Using existing data from a randomized controlled trial (RCT) targeting maternal and infant health disparities, this study aims to (1) explore predictors of peripartum care attendance and (2) examine clinical trial sample representativeness.
Methods: The analyses addressing the primary aim of the study included Black women at risk for low prenatal care (PNC) engagement who consented to RCT participation and had a documented live birth (n = 123). For the secondary study aim, comparisons between women who consented to the RCT (Consenters; n = 149) and those who did not (Non-consenters; n = 122) were made using chi-square and t-tests.
Results: Hierarchical linear and logistic regression identified predictors of prenatal and postpartum care attendance, respectively. After controlling for multiple comparisons, no significant differences were identified between characteristics of Consenters and Non-consenters. Older age (p = 0.038), high-risk pregnancy (p < 0.001), and no past week substance use (p = 0.033) predicted better PNC attendance. PNC attendance predicted postpartum visit attendance (p < 0.001).
Conclusions: This study provides benchmark data on predictors of peripartum care and sample representativeness in RCTs. Findings have important implications for health care system changes and development of culturally informed interventions.
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References
1. Kassebaum NJ, Barber RM, Bhutta ZA, et al. Global, regional, and national levels of maternal mortality, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1775–1812.
2. CDC. Pregnancy Mortality Surveillance System, 2020. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm Accessed August 1, 2020.
3. Petersen EE, Davis NL, Goodman D, et al. Vital signs: Pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423–429.
4. Mazul MC, Salm Ward TC, Ngui EM. Anatomy of good prenatal care: Perspectives of low income african-american women on barriers and facilitators to prenatal care. J Racial Ethn Health Disparities 2017;4:79–86.
5. Burris HH, Hacker MR. Birth outcome racial disparities: A result of intersecting social and environmental factors. Semin Perinatol 2017;41:360–366.
6. Somer SJH, Sinkey RG, Bryant AS. Epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality. Semin Perinatol 2017;41:258–265.
7. Mikhail B. Prenatal care utilization among low-income African American women prenatal care. J Community Health Nurs 2000;17:235–246.
8. Partridge S, Balayla J, Holcroft CA, Abenhaim HA. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: A retrospective analysis of 28,729,765 U.S. deliveries over 8 years. Am J Perinatol 2012;29:787–793.
9. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 2010;202:335–343.
10. Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Semin Perinatol 2017;41:308–317.
11. Gee GC, Ford CL. Structural racism and health inequities: Old issues, new directions. Du Bois Rev 2011;8:115–132.
12. ACOG. ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol 2018;131:e140–e150.
13. Osterman MJK, Martin JA. Timing and adequacy of prenatal care in the United States, 2016. Natl Vital Stat Rep 2018;67:1–14.
14. ACOG. ACOG Committee Opinion No. 649: Racial and ethnic disparities in obstetrics and gynecology. Obstet Gynecol 2015;126:e130–e134.
15. Louis JM, Menard MK, Gee RE. Racial and ethnic disparities in maternal morbidity and mortality. Obstet Gynecol 2015;125:690–694.
16. Thiel de Bocanegra H, Braughton M, Bradsberry M, Howell M, Logan J, Schwarz EB. Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program. Am J Obstet Gynecol 2017;217:47.e1–47.e7.
17. Howell EA, Mora PA, Horowitz CR, Leventhal H. Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstet Gynecol 2005;105:1442–1450.
18. Jones KM, Power ML, Queenan JT, Schulkin J. Racial and ethnic disparities in breastfeeding. Breastfeed Med 2015;10:186–196.
19. Rankin KM, Haider S, Caskey R, Chakraborty A, Roesch P, Handler A. Healthcare utilization in the postpartum period among Illinois women with Medicaid paid claims for delivery, 2009–2010. Matern Child Health J 2016;20(Suppl 1):144–153.
20. Till SR, Everetts D, Haas DM. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database Syst Rev 2015:2015:CD009916.
21. Klerman LV, Ramey SL, Goldenberg RL, Marbury S, Hou J, Cliver SP. A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. Am J Public Health 2001;91:105–111.
22. Yee LM, Martinez NG, Nguyen AT, Hajjar N, Chen MJ, Simon MA. Using a patient navigator to improve postpartum care in an urban women's health clinic. Obstet Gynecol 2017;129:925–933.
23. Svikis DS, Kelpin SS, Keyser-Marcus L, et al. Increasing prenatal care compliance in at-risk black women: Findings from a RCT of patient navigation and behavioral incentives. J Racial Ethn Health Disparities 2021;9:630–640.
24. Hensley L, Sulo S, Kozmic S, Parilla BV. Opioid addiction in pregnancy: Does depression negatively impact adherence with prenatal care? J Addict Med 2018;12:61–64.
25. Jamieson B. Exposure to interpersonal violence during pregnancy and its association with women's prenatal care utilization: A meta-analytic review. Trauma Violence Abuse 2020;21:904–921.
26. Weir S, Posner HE, Zhang J, Willis G, Baxter JD, Clark RE. Predictors of prenatal and postpartum care adequacy in a medicaid managed care population. Womens Health Issues 2011;21:277–285.
27. Morgan I, Hughes ME, Belcher H, Holmes L Jr. Maternal sociodemographic characteristics, experiences and health behaviors associated with postpartum care utilization: Evidence from Maryland PRAMS Dataset, 2012–2013. Matern Child Health J 2018;22:589–598.
28. Chen MJ, Hsia JK, Hou MY, Wilson MD, Creinin MD. Comparing postpartum visit attendance with a scheduled 2- to 3-week or 6-week visit after delivery. Am J Perinatol 2019;36:936–942.
29. DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers. J Pregnancy 2014;2014:530769.
30. Masho SW, Cha S, Karjane N, et al. Correlates of postpartum visits among medicaid recipients: An analysis using claims data from a managed care organization. J Womens Health (Larchmt) 2018;27:836–843.
31. Baer RJ, Altman MR, Oltman SP, et al. Maternal factors influencing late entry into prenatal care: a stratified analysis by race or ethnicity and insurance status. J Matern Fetal Neonatal Med 2019;32:3336–3342.
32. Orr ST, James SA, Reiter JP. Unintended pregnancy and prenatal behaviors among urban, black women in Baltimore, Maryland: the Baltimore preterm birth study. Ann Epidemiol 2008;18:545–551.
33. Noursi S, Saluja B, Richey L. Using the ecological systems theory to understand Black/White disparities in maternal morbidity and mortality in the United States. J Racial Ethn Health Disparities 2021;8:661–669.
34. Prather C, Fuller TR, Jeffries WL, 4th, et al. Racism, African American Women, and their sexual and reproductive health: A review of historical and contemporary evidence and implications for health equity. Health Equity 2018;2:249–259.
35. Kelpin SS, Ondersma SJ, Weaver M, Svikis DS. Representativeness of patients enrolled in a primary care clinical trial for heavy/problem substance use. Subst Abus 2018;39:469–475.
36. Kennedy-Martin T, Curtis S, Faries D, Robinson S, Johnston J. A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results. Trials 2015;16:495.
37. Lally J, Watkins R, Nash S, et al. The representativeness of participants with severe mental illness in a psychosocial clinical trial. Front Psychiatry 2018;9:654.
38. Masho SW, Keyser-Marcus L, Varner SB, Chapman D, Singleton R, Svikis D. Addressing perinatal disparities in urban setting: Using community based participatory research. J Community Psychol 2011;39:292–302.
39. Soeken KL, McFarlane J, Parker B, Lominack MC. The Abuse Assessment Screen: A clinical instrument to measure frequency, severity, and perpetrator of abuse against women. In: Empowering survivors of abuse: Health care for battered women and their children. Thousand Oaks, CA: Sage Publications, Inc., 1998:195–203.
40. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.
41. Cohen S, Hoberman HM. Positive events and social supports as buffers of life change stress. J Appl Soc Psychol 1983;13:99–125.
42. Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med Care 2003;41:1284–1292.
43. Feldhaus KM, Koziol-McLain J, Amsbury HL, Norton IM, Lowenstein SR, Abbott JT. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA 1997;277:1357–1361.
44. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994;84:1414–1420.
45. Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah: Taylor & Francis Group, 2002.
46. ACOG. Guidelines for perinatal care, 8th ed. Elk Grove Village: Elk Grove Village: American Academy of Pediatrics, 2017.
47. Carter EB, Tuuli MG, Caughey AB, Odibo AO, Macones GA, Cahill AG. Number of prenatal visits and pregnancy outcomes in low-risk women. J Perinatol 2016;36:178–181.
48. Pagnini DL, Reichman NE. Psychosocial factors and the timing of prenatal care among women in New Jersey's HealthStart program. Fam Plann Perspect 2000;32:56–64.
49. Greenfield SF, Brooks AJ, Gordon SM, et al. Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug Alcohol Depend 2007;86:1–21.
50. Polak K, Haug NA, Drachenberg HE, Svikis DS. Gender considerations in addiction: Implications for treatment. Curr Treat Options Psychiatry 2015;2:326–338.
51. Santoro TN, Santoro JD. Racial bias in the US opioid epidemic: A review of the history of systemic bias and implications for care. Cureus 2018;10:e3733.
52. Haug N, Osomo R, Yanovitch M, Svikis DS. Biopsychosocial approach to the management of drug and alcohol use in pregnancy. In: Edozien L, O'Brien P, eds. Biopsychosocial factors in obstetrics and gynecology. Cambridge, England: Cambridge University Press, 2017.
53. Frazer Z, McConnell K, Jansson LM. Treatment for substance use disorders in pregnant women: Motivators and barriers. Drug Alcohol Depend 2019;205:107652.
54. Baldwin MK, Hart KD, Rodriguez MI. Predictors for follow-up among postpartum patients enrolled in a clinical trial. Contraception 2018;98:228–231.
55. York R, Tulman L, Brown K. Postnatal care in low-income urban African American women: Relationship to level of prenatal care sought. J Perinatol 2000;20:34–40.
56. NIH. NIH Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research. 2017. https://grants.nih.gov/policy/inclusion/women-and-minorities/guidelines.htm Accessed August 1, 2020.
57. Begg C. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996;276:637–639.
58. Kelpin SS, Rusteikas SG, Karjane NW, Svikis DS. Screening for at-risk alcohol and drug use in the antenatal period: How do young women compare with older adult women? J Pediatr Adolesc Gynecol 2019;32:325–329.
Information & Authors
Information
Published In
Journal of Women's Health
Volume 31 • Issue Number 10 • October 2022
Pages: 1490 - 1500
PubMed: 35352968
Copyright
Copyright 2022, Mary Ann Liebert, Inc., publishers.
History
Published online: 26 October 2022
Published in print: October 2022
Published ahead of print: 23 March 2022
Topics
Authors
Authors' Contributions
All authors meet authorship criteria defined by the International Committee of medical Journal Editors. A.B.P.-A., D.S.S., and L.K.-M. contributed to the study conception and design. Analyses were performed by A.B.P.-A. and D.B. A.B.P.-A., D.S.S., and H.J. contributed to interpretation of the data. All authors contributed to drafting and revising initial versions of the article, as well as read and approved the final article.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
The parent RCT study was supported by Cooperative Agreement No. 5U58DP000983 from the Centers for Disease Control and Prevention.
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