Description of the problem. In the United States, about 10 percent of babies are born premature, which is before 37 weeks of pregnancy. Being born premature can cause serious problems; about two-thirds of babies who die in their first year of life were born premature, and premature babies who survive may have physical, mental, and neurodevelopmental problems. Low-income women, as well as women who are Black, Latina, Pacific Islander or Native American, are more likely to have a premature baby than other women. The reasons for these disparities are unknown, although some studies suggest that depression, anxiety, and other factors may increase a woman’s chances of having a premature baby. Fresno County has the highest rate of prematurity in California.
Currently, Fresno has two prenatal care programs to help women get support and services to help ensure a healthy baby. The Glow: Group Prenatal Care and Support (Glow/GC) program consists of prenatal care in a group of women with similar due dates, plus services focused on other needs. The Comprehensive Perinatal Service Program provides additional services to women who are receiving prenatal care in the usual one-on-one format (CPSP/IC). We don’t know which approach results in the lowest rate of prematurity, or which is more helpful in decreasing depression and anxiety and improving the experience of prenatal care.
Outcomes we hope to achieve. We will conduct a study comparing Glow/GC to CPSP/IC. About 2,200 Medicaid-eligible English- or Spanish-speaking women who are less than 20 weeks pregnant will be assigned to Glow/GC or CPSP/IC. They will complete surveys during their second and third trimesters, and at 6 weeks and 3 months postpartum, to measure depression, anxiety, and experience of care. We will look at their medical records to find out whether their baby was born premature. Our hope is that the results of our study will help future patients decide which approach is best for them, and help providers and policy makers decide which program is best suited to address high rates of prematurity, depression, and anxiety, and disrespectful care.
Importance of problem to patients. Patient stakeholders in Fresno have told us that having healthy babies, feeling less depressed and anxious, and receiving respectful prenatal care are the outcomes that matter most to them. With these patient stakeholders, as well as community prenatal care providers and representatives from community organizations, we have designed a study to determine the best way to address these critically important outcomes.
How patients and other stakeholder partners will help to make the project successful. Our stakeholder partners helped design the study, including which practices to include, how to recruit study participants, and how to ensure that participants complete the study and provide meaningful data. Many patients who used one of these prenatal care programs are now members of our advisory board; others have joined as research staff members. All are committed to helping find solutions to these serious problems, and to spreading the word on our results once the study is complete.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.