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

摘要 居住在美国（US）的太平洋岛民的早产率非常高（<37 低出生体重儿（<2，500克）。他们也更容易患先兆子痫， 原发性剖宫产、妊娠期体重过度增加和妊娠期糖尿病（GDM）的比较 对其他种族/少数民族和一般美国人口。这些产妇保健因素， 产妇和婴儿发病率和死亡率的前兆。太平洋岛民的婴儿出生率几乎是 与非西班牙裔白人相比，每1 000名活产婴儿的死亡率更高，孕产妇死亡率更高 与非西班牙裔白人相比（13.5对12.7）。早期和持续的支持性护理 怀孕连续性与积极的生育结果密切相关，是全球卫生优先事项。 然而，太平洋岛民不太可能得到适当的产前和产后护理，因此处于一种 产妇和婴儿发病率和死亡率风险较高。 新出现的文献表明，以小组为基础的产前计划，如集中怀孕，加上 护理导航，可以减轻严重发病率和死亡率的前兆，如：产前和产后护理不足， 产后护理预约，早产，低出生体重儿，剖腹产， 急诊室就诊和获得社会支持服务。然而，集团产前护理与护理 在马绍尔群岛或其他太平洋岛民中，导航尚未进行过测试。拟定研究 将确定中心妊娠与护理导航的可行性和初步有效性， 改善：产前和产后保健预约、早产、低出生体重儿 剖腹产、急诊和获得社会支持服务。我们将使用混合- 两组马绍尔妇女的方法（相关协变量的倾向评分匹配 如产妇年龄、产次和社会人口统计学），一组在以护理导航为中心的妊娠中 另一组来自标准产前护理。 这项研究将产生急需的数据，说明使用护理导航的中心妊娠的可行性， 通过护理导航员改善孕产妇健康结果和支持性护理的初步成效， 被忽视的人群本研究的信息将为协作检验多水平提供基础 采取行为干预措施，改善太平洋岛屿国家预防孕产妇和发病率及死亡率的努力 岛民，在一个更大的NIH R 01或以患者为中心的结果研究所试验。

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.