This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.
What is the research about?
In the United States, Black mothers are more likely than White mothers to have pregnancy complications, such as having a baby with low birthweight. Black mothers who experience racial bias in the healthcare system are at even greater risk of pregnancy complications. Improving the quality of health care and understanding of racial bias among doctors, nurses, and other clinic staff may help improve pregnancy outcomes for Black mothers.
In this study, the research team is comparing four ways to provide pregnancy care to Black patients. All four ways include usual care. In usual care, clinics screen pregnant patients who have North Carolina Medicaid insurance for risk factors for having a baby with low birthweight. Patients at high risk receive intensive care management, which includes resources and referrals to other health services in their community. The four ways are:
- Usual care plus racial equity training, data alerts, and reports for clinic staff. Clinic staff complete racial equity training focused on pregnancy care. They also receive data alerts from patients’ health records when a patient misses an appointment or has elevated blood pressure. The research team shares reports on clinic data with clinic staff. Reports show practice-level patient outcomes, such as low birthweight and other pregnancy complications, by race.
- Usual care plus racial equity training for clinic staff and doula support for patients. Clinic staff complete racial equity training focused on pregnancy care. Patients also receive physical, educational, and emotional support from community-based doulas. Doulas are trained professionals who provide educational, physical, and spiritual support before, during, and after childbirth. Doulas go to two prenatal visits, are present during labor, and visit patients at their home up to one year after birth. Doulas also set up peer support groups for patients with similar due dates.
- Usual care plus racial equity training, data alerts and reports for clinic staff, and doula support for patients. Clinics and patients receive usual care plus both of the above approaches.
- Usual care alone.
Who can this research help?
Results may help prenatal clinics when considering ways to reduce pregnancy complications among Black mothers.
What is the research team doing?
The study includes 40 prenatal clinics in North Carolina. The research team is assigning clinics by chance to provide pregnancy care in one of the four ways for two years.
The research team is reviewing health records for at least 30,000 patients who receive prenatal care at one of the 40 clinics. The team is looking at babies’ birthweight and how patients used healthcare services during and after pregnancy.
Also, the research team is surveying up to 4,000 Black patients receiving care at one of the 40 clinics. Patients take the surveys four times between their first prenatal visit and four months after delivery. Surveys ask about patients’ experiences with racial bias during pregnancy care; they also ask about depression.
Finally, the team is interviewing up to 463 clinic staff, community-based doulas, and patients about their thoughts on pregnancy care.
Black mothers who had a pregnancy complication, doulas, health insurers, and patient advocates are helping to plan and conduct the study. The North Carolina Division of Public Health is providing input on the study.
Research methods at a glance
|Randomized controlled trial
Aim 1: Health records for at least 30,000 Black pregnant persons receiving care at 1 of 40 prenatal clinics in North Carolina
Aim 2: Up to 4,000 Black pregnant persons receiving care at 1 of 40 prenatal clinics in North Carolina
Aim 3: Up to 463 practice staff, doulas, patients, and practice facilitators across the 40 prenatal clinics
Primary: low birthweight deliveries, experiences of discrimination during prenatal care
Secondary: emergency care visits during pregnancy, maternal hospitalizations and emergency care visits during first year post-delivery, infant hospitalizations and emergency care visits during first year post-delivery, postpartum visit attendance, severe maternal morbidity, hypertensive disorders of pregnancy, cesarean section, level of depression, racism knowledge among providers
|Up until birth for primary outcomes