Improving the Quality of Prenatal Care for Low-Income, At-Risk Women

PROJECT SUMMARY/ABSTRACT: PROJECT 5 (SMITH) Background: The U.S. has the highest rate of maternal deaths in the developed world and over 60% of maternal deaths in the U.S. are preventable. Preeclampsia, a disorder of pregnancy characterized by hypertension and proteinuria, is a top preventable cause of maternal death the U.S. Chronic hypertension, a major risk factor for preeclampsia, is estimated to be present in 3% to 5% of all pregnancies. Research suggests that women at high-risk for preeclampsia receive 81 to 150 mg of aspirin and counseling on and self-monitor their high blood pressure between 11-16 until 36 weeks of gestation. The brief duration of typical prenatal visits (10 minutes on average) hinders the provider’s ability to deliver evidence-based preeclampsia education and counseling. To date, current research does not, moreover, take advantage of innovative and evidence-based models of prenatal care and hypertension control that have proven feasible for providers and patients. Thus, there is a critical need to implement and deliver guideline-consistent preeclampsia prevention in a sustainable model that removes obstacles to care for at-risk women. Study Design: The long-term goal of this project is to reduce needless preeclampsia and preeclampsia-related deaths among low income, at-risk pregnant women by increasing access to evidence-based care. The objective of this study is to refine and pilot test a novel intervention that is designed to address patient and provider obstacles to preeclampsia prevention. The intervention, Centering HER (Health, Empowerment, and Reproduction), combines a well-established and effective group prenatal care model—Centering Pregnancy—with a promising telemedicine-based hypertension control program—Take Control of Your Blood Pressure. To meet our study objective, the study proposes the following specific aims: 1) To gain end-user input on the feasibility and acceptability of Centering HER, 2) To pilot the revised Centering HER and collect feasibility and intermediate outcome data, and 3) To determine the effectiveness of Centering HER to improve blood pressure monitoring, aspirin adherence, and implementation measures. Potential Impact: The successful completion of the aims will be important to address the cornerstones of preeclampsia prevention—prenatal care, medication adherence, and blood pressure monitoring. If efficacious, Centering HER may be a low cost, sustainable, translatable option to prevent preeclampsia in at-risk populations.