Exploring the Preliminary Efficacy of Centering Pregnancy with Care Navigation to Reduce Maternal Health Disparities among Marshallese Women

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Abstract Pacific Islanders residing in the United States (US) have disproportionally high rates of preterm birth (<37 weeks) and low birthweight infants (<2,500 grams). They are also more likely to experience preeclampsia, primary cesarean birth, excessive gestational weight gain, and gestational diabetes mellitus (GDM) compared to other racial/ethnic minorities and the US population in general. These maternal health factors serve as precursors to maternal and infant morbidity and mortality. Pacific Islanders have almost twice the infant mortality rate, per 1,000 live births, as compared to non-Hispanic whites and have a higher maternal mortality rate compared to non-Hispanic whites (13.5 verse 12.7). Early and consistent supportive care throughout the pregnancy continuum is strongly associated with positive birth outcomes and is a global health priority. However, Pacific Islanders are less likely to receive adequate prenatal and postpartum care and are thus at a higher risk for maternal and infant morbidity and mortality. Emerging literature suggests that group-based prenatal programs, like Centering Pregnancy, coupled with care navigation, can mitigate precursors to severe morbidity and mortality such as: inadequate prenatal and postpartum care appointment attendance, preterm birth, low-birth weight infants, cesarean deliveries, emergency department visits, and access to social support services. However, group prenatal care with care navigation has not been tested with the Marshallese or other Pacific Islanders in the US. The proposed study will determine the feasibility of Centering Pregnancy with care navigation and the preliminary effectiveness to improve: prenatal and postpartum care appointment attendance, preterm birth, low-birth weight infants, cesarean deliveries, emergency department visits, and access to social support services. We will use a mixed- method approach with two groups of Marshallese women (propensity score matched on relevant covariates such as maternal age, parity, and sociodemographics), one group in Centering Pregnancy with care navigation and one group from standard prenatal care. The study will yield much-needed data on the feasibility of Centering Pregnancy with care navigation and the preliminary effectiveness to improve maternal health outcomes and supportive care with care navigators in an understudied population. Information from this study will provide the foundation to collaboratively test multilevel behavioral interventions to improve maternal and morbidity and mortality prevention efforts among Pacific Islanders, in a larger NIH R01 or Patient Centered Outcomes Research Institute trials.