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. 2001 Jan;91(1):105–111. doi: 10.2105/ajph.91.1.105

A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women.

L V Klerman 1, S L Ramey 1, R L Goldenberg 1, S Marbury 1, J Hou 1, S P Cliver 1
PMCID: PMC1446489  PMID: 11189800

Abstract

OBJECTIVES: This project investigated whether augmented prenatal care for high-risk African American women would improve pregnancy outcomes and patients' knowledge of risks, satisfaction with care, and behavior. METHODS: The women enrolled were African American, were eligible for Medicaid, had scored 10 or higher on a risk assessment scale, were 16 years or older, and had no major medical complications. They were randomly assigned to augmented care (n = 318) or usual care (n = 301). Augmented care included educationally oriented peer groups, additional appointments, extended time with clinicians, and other supports. RESULTS: Women in augmented care rated their care as more helpful, knew more about their risk conditions, and spent more time with their nurse-providers than did women in usual care. More smokers in augmented care quit smoking. Pregnancy outcomes did not differ significantly between the groups; however, among patients in augmented care, rates of preterm births were lower and cesarean deliveries and stays in neonatal intensive care units occurred in smaller proportions. Both groups had lower-than-predicted rates of low birthweight. CONCLUSIONS: High-quality prenatal care, emphasizing education, health promotion, and social support, significantly increased women's satisfaction, knowledge of risk conditions, and perceived mastery in their lives, but it did not reduce low birthweight.

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Selected References

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  1. Andrews W. W., Goldenberg R. L., Hauth J. C. Preterm labor: emerging role of genital tract infections. Infect Agents Dis. 1995 Dec;4(4):196–211. [PubMed] [Google Scholar]
  2. Baldwin L. M., Larson E. H., Connell F. A., Nordlund D., Cain K. C., Cawthon M. L., Byrns P., Rosenblatt R. A. The effect of expanding Medicaid prenatal services on birth outcomes. Am J Public Health. 1998 Nov;88(11):1623–1629. doi: 10.2105/ajph.88.11.1623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Buescher P. A., Roth M. S., Williams D., Goforth C. M. An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. Am J Public Health. 1991 Dec;81(12):1625–1629. doi: 10.2105/ajph.81.12.1625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ershoff D. H., Mullen P. D., Quinn V. P. A randomized trial of a serialized self-help smoking cessation program for pregnant women in an HMO. Am J Public Health. 1989 Feb;79(2):182–187. doi: 10.2105/ajph.79.2.182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Goldenberg R. L., Andrews W. W. Intrauterine infection and why preterm prevention programs have failed. Am J Public Health. 1996 Jun;86(6):781–783. doi: 10.2105/ajph.86.6.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Goldenberg R. L., Cliver S. P., Mulvihill F. X., Hickey C. A., Hoffman H. J., Klerman L. V., Johnson M. J. Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women. Am J Obstet Gynecol. 1996 Nov;175(5):1317–1324. doi: 10.1016/s0002-9378(96)70048-0. [DOI] [PubMed] [Google Scholar]
  7. Goldenberg R. L., Hickey C. A., Cliver S. P., Gotlieb S., Woolley T. W., Hoffman H. J. Abbreviated scale for the assessment of psychosocial status in pregnancy: development and evaluation. Acta Obstet Gynecol Scand Suppl. 1997;165:19–29. [PubMed] [Google Scholar]
  8. Goldenberg R. L., Rouse D. J. Prevention of premature birth. N Engl J Med. 1998 Jul 30;339(5):313–320. doi: 10.1056/NEJM199807303390506. [DOI] [PubMed] [Google Scholar]
  9. Goldenberg R. L., Tamura T., Neggers Y., Copper R. L., Johnston K. E., DuBard M. B., Hauth J. C. The effect of zinc supplementation on pregnancy outcome. JAMA. 1995 Aug 9;274(6):463–468. doi: 10.1001/jama.1995.03530060037030. [DOI] [PubMed] [Google Scholar]
  10. Handler A., Raube K., Kelley M. A., Giachello A. Women's satisfaction with prenatal care settings: a focus group study. Birth. 1996 Mar;23(1):31–37. doi: 10.1111/j.1523-536x.1996.tb00458.x. [DOI] [PubMed] [Google Scholar]
  11. Handler A., Rosenberg D., Raube K., Kelley M. A. Health care characteristics associated with women's satisfaction with prenatal care. Med Care. 1998 May;36(5):679–694. doi: 10.1097/00005650-199805000-00008. [DOI] [PubMed] [Google Scholar]
  12. Joyce T. Impact of augmented prenatal care on birth outcomes of Medicaid recipients in New York City. J Health Econ. 1999 Jan;18(1):31–67. doi: 10.1016/s0167-6296(98)00027-7. [DOI] [PubMed] [Google Scholar]
  13. Kogan M. D., Alexander G. R., Kotelchuck M., Nagey D. A., Jack B. W. Comparing mothers' reports on the content of prenatal care received with recommended national guidelines for care. Public Health Rep. 1994 Sep-Oct;109(5):637–646. [PMC free article] [PubMed] [Google Scholar]
  14. Korenbrot C. C., Gill A., Clayson Z., Patterson E. Evaluation of California's statewide implementation of enhanced perinatal services as Medicaid benefits. Public Health Rep. 1995 Mar-Apr;110(2):125–133. [PMC free article] [PubMed] [Google Scholar]
  15. McLaughlin F. J., Altemeier W. A., Christensen M. J., Sherrod K. B., Dietrich M. S., Stern D. T. Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight. Pediatrics. 1992 Jan;89(1):128–132. [PubMed] [Google Scholar]
  16. Olds D. L., Henderson C. R., Jr, Tatelbaum R., Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. 1986 Jan;77(1):16–28. [PubMed] [Google Scholar]
  17. Reichman N. E., Florio M. J. The effects of enriched prenatal care services on Medicaid birth outcomes in New Jersey. J Health Econ. 1996 Aug;15(4):455–476. doi: 10.1016/s0167-6296(96)00491-2. [DOI] [PubMed] [Google Scholar]
  18. Ventura S. J., Martin J. A., Curtin S. C., Mathews T. J. Births: final data for 1997. Natl Vital Stat Rep. 1999 Apr 29;47(18):1–96. [PubMed] [Google Scholar]
  19. Williams R. L., Creasy R. K., Cunningham G. C., Hawes W. E., Norris F. D., Tashiro M. Fetal growth and perinatal viability in California. Obstet Gynecol. 1982 May;59(5):624–632. [PubMed] [Google Scholar]

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