Poster Session 3
Kate Tolleson, MS (she/her/hers)
Medical Student
NYU Grossman School of Medicine
New York, New York, United States
Jessica Britt, PhD
Biostatistician
Prisma Health
Prisma Health, SC, United States
Moonseong Heo, BA, MA, PhD
Clemson University
Clemson, South Carolina, United States
Amy Crockett, MD, MSPH (she/her/hers)
Professor
Prisma Health and University of South Carolina School of Medicine
Greenville, South Carolina, United States
The 6 week postpartum visit (PPV) is an opportunity for family planning, evaluation of physical and mental health, and a link to follow-up for chronic health conditions. Many patients miss this visit, with attendance averaging 61%. Participation in group prenatal care (GPNC) encourages patient engagement during pregnancy and may improve PPV attendance. We compared rates of PPV attendance between GPNC and individual prenatal care (IPNC).
Study Design:
Secondary analysis of a prospective clinical trial comparing GPNC vs IPNC on birth outcomes. The primary outcome variable was PPV attendance. Comparisons were made using 3 analytic approaches: intent-to-treat (ITT) including all randomized participants, modified ITT (mITT) including participants attending ≥1 visit in the assigned study arm, and a per compliance (PC) including those receiving ≥5 visits in the assigned study arm. Comparisons with χ-square and t-test were performed for mITT and PC groups and logistic regression was used to control for differences between groups.
Results: 2348 participants were enrolled with 1175 in GPNC and 1173 in IPNC. Participants were 40% Black, 36% White, and 21% Hispanic. Compared with IPNC, GPNC did not have higher rates of PPV attendance in ITT (61% GPNC vs 61% IPNC, RR 1.01, 95% CI 0.942-1.07). However, with increasing participation, GPNC had significantly higher PPV attendance in mITT (70% vs 64%, RR 1.10, 95% CI 1.03-1.17) and PC (76% vs 66%, RR 1.14,95% CI 1.07-1.21). Adequacy of Prenatal Care Utilization Index ≥ 3 was associated with PPV attendance (RR 2.52,95% CI 2.16-2.94) regardless of prenatal care type. Participants with 1+ living children had significantly less PPV attendance compared to participants with no living children (58% vs 65%, RR 0.892, 95% CI 0.84-0.95).
Conclusion:
There were no significant differences in PPV attendance between GPNC and IPNC in ITT, but increased participation in GPNC was associated with increased PPV attendance. Efforts to improve adequacy of prenatal care will be beneficial to all patients. Innovation in prenatal care delivery is needed to improve overall PPV attendance.
