Online Program

South Carolina CenteringPregnancy Expansion Project: Improving racial disparities in birth outcomes for a low-income population

Tuesday, November 3, 2015

Liwei Chen, MD, PhD, MHS, Department of Public Health Sciences, Clemson University, Clemson, SC
Emily Heberlein, Department of Public Health, Clemson University, Clemson, SC
Sarah Covington-Kolb, MSPH, MSW, OB-GYN Center, Greenville Hospital System, Greenville, SC
Amy Picklesimer, MD, MSPH, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine - Greenville, Greenville, SC
BACKGROUND: To improve birth outcomes and reduce racial disparities, South Carolina Department of Health and Human Services sponsored the expansion of CenteringPregnancy group prenatal care (CPNC) in obstetric practices serving low-income women.  

METHODS: This is a retrospective cohort study of women who received CPNC from seven sites (implemented CPNC prior to 2014) and had a live birth between August, 2013 and September, 2014, compared with women from the same practices receiving standard individual prenatal care (IPNC).  Using state vital statistics and Medicaid claims databases, multivariate regressions were conducted to examine differences in birth outcomes with adjustment for demographic and clinical risk factors. 

RESULTS: The crude preterm birth (PTB; < 37 weeks) rate was 10.98% in IPNC (N=6,803) and 8.28% in CPNC (N=604) (P=0.04). Greater difference was found in Black (12.70% vs. 4.92%; P <0.001) than in White women (9.71% vs. 8.39%; P=0.48). Adjusted odds ratio (OR) for PTB for women in CPNC was 0.67 (P=0.01): 0.35 (P<0.001) in Blacks and 0.71 (P=0.15) in Whites. Unadjusted rates of adequacy of prenatal care and breastfeeding were higher for CPNC women (P<0.001). There was no difference in low birth weight rate but the adjusted birth weight was 59g (P=0.02) greater in CPNC compared with IPNC: 70g greater (P=0.08) in Blacks and 50g greater (P=0.16) Whites.    

CONCLUSIONS: Interim results indicate statewide implementation of CPNC in practices serving low-income women improves the rate of PTB and other birth outcomes as compared to IPNC, with greater benefits found in Black women.

Learning Areas:

Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Demonstrate the South Carolina CenteringPregnancy Expansion Project funded by the South Carolina Department of Health and Human Services. Evaluate the pregnancy and birth outcomes of women who received CenteringPregnancy group prenatal care compared with women from the same practices receiving standard individual prenatal care.

Keyword(s): Birth Outcomes, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a maternal-fetal medicine physician with a masters degree in public health. My practice has been providing CenteringPregnancy group prenatal care since 2008. I have research interests in racial disparities, outpatient obstetrics and public policy.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.