(800) Prenatal Clinic Management of High-Risk Pregnant Patients

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Kenechukwu Odenigbo, BA

University of Michigan Medical School
Ann Arbor, Michigan, United States

Coauthor(s)

Harini Pennathur, BSE (she/her/hers)

Texas A&M University School of Engineering Medicine, United States
Rachel A. Clark, BS (she/her/hers)

University of Michigan Medical School
Ann Arbor, Michigan, United States
Jourdan E. Triebwasser, MA, MD (she/her/hers)

Clinical Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
SP

Shayla Parthasarathy, BS

University of Michigan Medical School
Ann Arbor, Michigan, United States
Michelle Moniz, MD, MSc (she/her/hers)

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
Lisa Kane Low, CNM, PhD (she/her/hers)

University of Michigan
Ann Arbor, Michigan, United States
Alex Peahl, MD, MSc (she/her/hers)

Michigan Medicine
Ann Arbor, Michigan, United States

Objective: To describe how prenatal clinics in the state of Michigan manage patients with high-risk conditions in pregnancy.

Study Design: Prenatal care providers were identified and recruited through a systematic web search and snowball sampling. Semi-structured surveys assessed prenatal care practices for birthing people with high-risk conditions (e.g. pre-existing diabetes, chronic hypertension). Clinics reported whether they managed, co-managed, or referred patients. We assessed differences in practice by clinic type: Federally Qualified Health Centers, outpatient clinics linked to hospitals, and private practices using basic tests of comparison. Qualitative content analysis was used to summarize free-response answers about additional services offered to medically complex patients. Funding provided by Blue Cross Blue Shield of Michigan.

Results:
In total, 19 clinics representing 8/10 regions, with an average of 408 (range 20-1700) patients per site, were included. Of the 19 clinics, 9/19 (47.4% ) manage, 6/19 (31.6%) co-manage, and 4/19 (21.1%) refer pregnant patients with pre-existing type 2 diabetes. More outpatient clinics linked to hospitals managed patients with pre-existing type 2 diabetes. For patients with chronic hypertension, 11/19 (57.9%) clinics manage, 6/19 (31.6%) co-manage, and 2/10 (10.5%) refer patients. Management practices for chronic hypertension did not differ by clinic type. Additional services offered to medically complex patients included nurse navigators; care coordination by nurses, faculty, and trainees; support from social workers, therapists, doulas, or community health workers; and access to maternal fetal medicine physicians.

Conclusion: Many patients with type 2 diabetes or chronic hypertension require referrals or management from multiple providers. Future work is needed to understand the effects of varying management practices for chronic conditions on care access and outcomes, and the effects of additional services such as care coordination.