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Increasing the quality and quantity of prenatal care may not reduce low birthweight among low-income black women

Several approaches have been used to reduce low birthweight (LBW) and preterm birth among poor minority women who are at higher risk for such births. While high-quality prenatal care can improve knowledge about pregnancy risk, social support, care satisfaction, and a sense of control over their lives, it does not reduce low birthweight among poor black women at high risk for LBW infants. This is the conclusion of a recently published study by the Low Birthweight Patient Outcomes Research Team (PORT) and supported by the Agency for Healthcare Research and Quality (PORT contract 290-92-0055). The PORT was led by Robert L. Goldenberg, M.D., of the University of Alabama at Birmingham.

Dr. Goldenberg and his colleagues Lorraine Klerman, Dr.P.H., and Sharon Ramey, Ph.D., randomly assigned 318 Medicaid-eligible pregnant black women (less than 26 weeks gestation) to augmented prenatal care and 301 similar women to usual care. These women had at least one of ten or more risk factors for having LBW babies.

Augmented care included educationally oriented peer groups, additional appointments (two a month and then weekly after 36 weeks), extended time with clinicians, and other supports. Specific risk-reduction programs addressed smoking cessation, weight gain, vitamin/mineral supplementation, and resolution of psychosocial stress/isolation. Also, the program provided transportation, child care, appointment reminders, patient education, and discussion groups, and members of the women's social support systems were encouraged to come to the center.

Both groups had lower than predicted rates of LBW, but augmented care did not reduce LBW. Although the mean birthweight of live-born infants was somewhat higher in augmented care than in usual care (6.75 lbs vs. 6.68 lbs), the percentage of infants weighing less than 5.5 lbs was slightly higher in augmented care (12.5 vs. 11.2 percent). However, women who had given birth before said that care at the Mother and Family Specialty Center (augmented care) was better this time (74 vs. 30 percent for usual care). Women in augmented care rated their care as more helpful, they knew more about their risks for giving birth to LBW babies, and they spent more time with their nurse-providers than did women in usual care. Also, women in the augmented care group participated in prenatal or childbirth groups more than women receiving usual care (79 vs. 17 percent), and more smokers in augmented care quit smoking.

See "A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women," by Drs. Klerman, Ramey, Goldenberg, and others, in the January 2001 American Journal of Public Health 91, pp. 105-111.

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