Date of Award

Fall 2021

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

First Advisor

Elizabeth Crouch

Second Advisor

Jihong Liu

Abstract

The primary focus of this dissertation is to evaluate the health impact of the CenteringPregnancy (CP) program versus traditional prenatal care (TPNC) on important maternal outcomes of pregnancy. This is looked at in two outcomes-gestational weight gain (GWG) and pregnancy induced hypertension (PIH). The specific aims are to examine the: (1) effects of CenteringPregnancy program versus traditional prenatal care on gestational weight gain (GWG); (2) effects of CenteringPregnancy program versus traditional prenatal care on pregnancy induced hypertension (PIH).

Birth certificate (BC) data were linked to hospital discharge records of women who delivered in midland’s obstetric clinics of South Carolina between 2015 and 2019. The research project first validated the accuracy of GWG records on birth certificate data in a sub-sample of centering women (30%) before conducting the evaluation as previous studies suggested the need for this. Propensity score analysis (PSA) was used to account for confounding of patient characteristics and lack of randomization to treatment.

The result from validation study showed that BC data for GWG records were similar to electronic medical records, the gold standard and can provide reasonable estimate of this variable for the evaluation, and thus BC is a valid database. For aim one, the study found no statistically significant association between Centering Pregnancy program (versus TPNC) and total gestational weight gain (using it as either continuous or categorical variable-adequate, inadequate, and excessive weight gain) in all analysis models (unadjusted, adjusted, propensity score covariate adjusted and inverse probability to treatment weighting (propensity score weighting) method. The same pattern was observed for weekly rate of weight gain. These are the analytical ways of assessing gestational weight gain as recommended by IOM guideline. For study two, CenteringPregnancy had higher odds of pregnancy induced hypertension in combined stratum in all models-unadjusted, adjusted, propensity score covariate adjusted and inverse probability to treatment weighting method (for unadjusted-OR 1.76, 95%CI, 1.43, 2.17), and specifically significantly increased in all models with development gestational hypertension/unspecified hypertension (for unadjusted- OR 1.91, 95% CI, 1.48, 2.45) compared to women that had TPNC which is opposite to our hypothesis. We also found statistically significant increased odds of severe pre-eclampsia/eclampsia in only unadjusted model (OR 1.68, 95% CI, 1.14, 2.49) among CP participants compare to their counterparts in TPNC but surprisingly, mild pre-eclampsia was not statistically significantly associated in all models. In summary, the study found no significant difference in GWG for women that enrolled in CP program compared to traditional prenatal care despite the special nutritional knowledge component of the program to help participant women achieve adequate weight gain in pregnancy as recommended by IOM guideline and the use of advanced statistical methods is opposite to our hypothesis. However, the no program effect is consistent with some prior evaluations that examined the association. We also recommend further studies, preferably a randomized controlled trial to look at the treatment effect in larger, similar or different population of centering women. Study two result needs to be interpreted with caution because there are many factors that may have contributed to the increase rate of pregnancy induced hypertension among centering women that we don’t have data for their fidelity. More studies are warranted in this area to critically investigate and appropriately ascribe the contributory factor (s) to increase rate of pregnancy induced hypertension among centering women despite the efforts for maternal well-being during pregnancy by the CP program. To our knowledge, this is the first study that examined the association between CP program and PIH.

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