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• CenteringPregnancy is a trademarked model of group prenatal care, in which groups of 8-10 pregnant women due to deliver in the same month attend a series of 10 group sessions which include not only the physical assessment of traditional prenatal care, but also cover a broad range of health education topics and offer opportunity for developing social support among group members.1 Participation in CenteringPregnancy has shown promise in reducing rates of preterm birth and improving the racial disparity in preterm birth.2,3

• To improve rates of preterm birth, and to reduce the racial disparities in preterm birth, the South Carolina Department of Health and Human Services sponsored a three year project to increase access to CenteringPregnancy group prenatal care.

• The South Carolina CenteringPregnancy Expansion Project provided 10 practice sites serving a high percentage of Medicaid-eligible women with start-up funding, training and technical expertise to implement CenteringPregnancy group prenatal care. All providers completed training from Centering Healthcare Institute faculty, and all sites were implementing the full CenteringPregnancy model of care.

BACKGROUND

• Retrospective cohort study of women who received CenteringPregnancy group prenatal care at one of seven study sites, and delivered in the hospital(s) affiliated with each practice.

• The comparison group included Medicaid-enrolled women receiving individual prenatal care and delivering in the same hospitals during the same time period. Delivery in the same hospital was used as a proxy for receiving prenatal care from the same practice.

• Patients delivered between August 2013 and September 2014.

Participation in group prenatal care is limited to medically low risk women, therefore the following exclusions were applied to both groups: • multiple gestation• pregestational diabetes • chronic hypertension • BMI >45 kg/m2

• Entry to prenatal care >4 months

Data were obtained through state vital statistics. Multivariate logistic regression performed for the entire cohort, then stratified by race, were conducted to examine differences in the odds of preterm birth by prenatal care model after adjusting for demographic and risk factors.

MATERIALS AND METHODS

Table 1: Demographic characteristics by prenatal care group

RESULTS CONCLUSIONS

• Among this low income population, participation in the CenteringPregnancy group prenatal care improves the rate of preterm birth as compared to individual care, with greater benefits found in Black women.

• Reductions in the rate of preterm birth in this retrospective cohort are similar to previously published studies, including prospective randomized, controlled trials.2,3 Obtaining this outcome in multiple sites outside of a clinical trial demonstrates successful replication of the CenteringPregnancy model of care on a Statewide scale.

• The study is limited by possible selection bias; women at all sites were permitted to choose the type of prenatal care they received.

• Prospective, randomized trials are needed to explore causation and further reduce selection bias.

FUTURE DIRECTIONS

The expansion project is currently in year 3, and now includes 15 practices around South Carolina; plans are underway for an additional 6 sites.

Additional outcome data will be reported at the conclusion of the project in 2018.

ACKNOWLEDGEMENTS

The authors would like to thank the following organizations for their support for this research; the South Carolina Department of Health and Human Services, the South Carolina Chapter of the March of Dimes and the Greenville Health System Institute for Advancement of Healthcare. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders

Liwei Chen, PhD,1 Amy H. Picklesimer, MD, MSPH,2 Emily Heberlein, PhD,2 Sarah-Covington-Kolb, MSW, MSPH2

1 Department of Public Health Sciences, Clemson University, Clemson, SC 2Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC

South Carolina CenteringPregnancy Expansion Project: Improving racial disparities in birth outcomes for a low income population

OBJECTIVE

To evaluate birth outcomes for women in the South Carolina CenteringPregnancy Expansion Project at the end of year 1 (7 sites).

0%

2%

4%

6%

8%

10%

12%

14%

Preterm < 37 weeks

Black White0%

2%

4%

6%

8%

10%

12%

14%

Preterm <37 weeks by race

CP IPNC

9.8%8.8%

10.6%

5.2%

11.7%

8.3%

Adjusted odds ratios for preterm birth for Centering participants: Full cohort: 0.66 (95% CI 0.45-0.97, P = 0.03)*

Black women: 0.40 (95% CI 0.18-0.78, P = 0.009)* White women: 0.73 (95% CI 0.41-1.31, P = 0.28)*

* adjusted for age, education, race, parity, Kotelchuck index, time of entering prenatal care, and previous preterm birth history.

P=0.50P=0.01Entire CohortP=0.04

REFERENCES

1 Rising, S. S., Kennedy, H. P., & Klima, C. S. (2004). Redesigning prenatal care through CenteringPregnancy. J Midwifery Womens Health, 49(5), 398-404.

2 Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S. S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstet. Gynecol., 110(2), 330-339.

3 Picklesimer, A. H., Billings, D., Hale, N., Blackhurst, D., & Covington-Kolb, S. (2012). The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. Am. J. Obstet. Gynecol., 206(5), 415.e411-415.e417. doi: 10.1016/j.ajog.2012.01.040