Reducing disparities in birth outcomes: a randomized controlled trial on CenteringPregnancy

 描述(由申请人提供)：在美国，早产(PTB)的发生率高得令人无法接受，黑人妇女受到的影响不成比例。到目前为止，医疗和公共卫生干预在改善生育结果方面取得的成功有限。部分问题可能是，过去几十年的努力主要集中在增加获得产前护理的机会上。出生结局的病因是复杂的，涉及行为、心理社会、社会人口、社区、环境和医学因素。怀孕期间的心理社会因素(如压力、焦虑、抑郁和应对反应)作为导致不良出生结局的关键因素正受到越来越多的关注。不全面解决这些更广泛因素的干预措施可能不太可能取得成功。对孕期集体产前护理(GPNC)的研究表明，将个人身体评估与促进的团体教育和同伴支持相结合的方法取得了令人振奋的结果，包括较高的产前护理使用率和护理满意度，以及肺结核发病率的改善。由于GPNC提供社会支持和更多的探视时间，增加了患者教育、自我护理技能和赋权，它认为 在改善出生结果和减少出生结果中的种族差异方面具有巨大的潜力。然而，还没有研究最终确定GPNC总体上对肺结核的影响，或者这种护理模式对肺结核患者种族差异的影响。之前的研究也没有确定 GPNC对患者教育、激活和压力的影响，这可能会影响分娩结局以及产后健康行为和结局。为了填补这一研究空白，我们建议进行一项随机对照试验(RCT)，比较参加GPNC的孕妇和传统个人产前护理(IPNC)的孕妇在生物医学、行为和心理社会结果方面的种族差异，并调查改善妇女的压力、活跃度和参与度是否将解释GPNC在结局和健康差异方面的潜在好处。这项试验将在南卡罗来纳州的一家大型产前护理中心进行，那里的历史肺结核发病率曾高达16.4%。符合条件的白人和黑人妇女将在20周孕龄之前被招募，并将在分娩和产后6周进行跟踪。

 DESCRIPTION (provided by applicant): Preterm birth (PTB) occurs at unacceptably high rates within the United States (U.S.), with Black women disproportionally affected. To date, medical and public health interventions have achieved limited success in improving birth outcomes. Part of the problem could be that the efforts in the last several decades focused mainly on increasing access to prenatal care. The etiology of birth outcomes is complex, involving behavioral, psychosocial, socio-demographic, community, environmental, and medical factors. Psychosocial factors during pregnancy (e.g. stress, anxiety, depression, and coping responses) are gaining increased attention as critical contributing factors to poor birth outcomes. Interventions that do not address these broader factors in a comprehensive way may be less able to achieve success. Studies of CenteringPregnancy group prenatal care (GPNC), where individual physical assessments are combined with facilitated group education and peer support, have demonstrated promising results, including high rates of prenatal care use and care satisfaction, and improvements in PTB rates. Because GPNC provides social support and more time for visits, increasing patient education, skills for self-care, and empowerment, it holds great potential for improving birth outcomes and reducing racial disparities in birth outcomes. However, no study has yet conclusively determined the effects of GPNC on PTB in general, or the effect of this care model on racial disparities in PTB. Prior research has also not established GPNC effects on patient education, activation, and stress, which may influence birth outcomes as well as health behaviors and outcomes beyond the postpartum period. To fill this research gap, we propose to conduct a randomized controlled trial (RCT) to compare biomedical, behavioral and psychosocial outcomes by race among pregnant women who participate in GPNC, to women in the traditional individual prenatal care (IPNC) and to investigate whether improving women's stress, activation and engagement will explain the potential benefits of GPNC on outcomes and health disparities. The trial will be conducted in a large prenatal care center in South Carolina where the historical PTB rate has been as high as 16.4%. Eligible White and Black women will be recruited before 20 weeks of gestational age and will be followed to delivery and 6 weeks postpartum.