Department of Psychology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Institute for Women's Health, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA.
J Womens Health (Larchmt). 2022 Oct;31(10):1490-1500. doi: 10.1089/jwh.2021.0197. Epub 2022 Mar 23.
The United States has unacceptably high rates of maternal and infant mortality, especially among Black women and their infants. Prenatal and postpartum care help reduce maternal and infant morbidity and mortality; however, Black women are less likely to access and utilize peripartum care largely due to structural racism. Identifying factors that buffer against the systemic barriers disproportionately impacting this community is an important step in addressing racial health disparities. Using existing data from a randomized controlled trial (RCT) targeting maternal and infant health disparities, this study aims to (1) explore predictors of peripartum care attendance and (2) examine clinical trial sample representativeness. The analyses addressing the primary aim of the study included Black women at risk for low prenatal care (PNC) engagement who consented to RCT participation and had a documented live birth ( = 123). For the secondary study aim, comparisons between women who consented to the RCT (Consenters; = 149) and those who did not (Non-consenters; = 122) were made using chi-square and -tests. Hierarchical linear and logistic regression identified predictors of prenatal and postpartum care attendance, respectively. After controlling for multiple comparisons, no significant differences were identified between characteristics of Consenters and Non-consenters. Older age ( = 0.038), high-risk pregnancy ( < 0.001), and no past week substance use ( = 0.033) predicted better PNC attendance. PNC attendance predicted postpartum visit attendance ( < 0.001). This study provides benchmark data on predictors of peripartum care and sample representativeness in RCTs. Findings have important implications for health care system changes and development of culturally informed interventions.
美国的孕产妇和婴儿死亡率居高不下，尤其是非裔美国女性及其婴儿。产前和产后护理有助于降低母婴发病率和死亡率；然而，由于结构性种族主义，非裔美国女性获得和利用围产期护理的可能性较小。确定可以缓解系统障碍的因素，这些障碍不成比例地影响到这个群体，是解决种族健康差异的重要一步。本研究利用针对母婴健康差异的随机对照试验（RCT）的现有数据，旨在：（1）探讨影响围产期护理参与的预测因素；（2）检验临床试验样本的代表性。分析解决了研究的主要目标，包括有低产前护理（PNC）参与风险的非裔美国女性，她们同意参与 RCT 并有记录的活产（=123）。为了实现第二个研究目标，对同意参与 RCT 的女性（Consenters；=149）和不同意参与的女性（Non-consenters；=122）进行了卡方检验和 t 检验。分层线性和逻辑回归分别确定了产前和产后护理参与的预测因素。在控制了多次比较后，Consenters 和 Non-consenters 的特征没有显著差异。年龄较大（=0.038）、高危妊娠（<0.001）和过去一周无物质使用（=0.033）预测了更好的 PNC 参与度。PNC 参与度预测了产后就诊参与度（<0.001）。本研究提供了 RCT 中围产期护理和样本代表性的预测因素基准数据。研究结果对医疗保健系统的变革和制定文化上有针对性的干预措施具有重要意义。
