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Primary Submission Category: Reproductive health
Comparing Enhanced Prenatal Care Delivery Models and Their Impact on Perinatal Social Determinants of Health: Evidence from the EMBRACE Study in California.
Authors: Vincenzo Cornacchione, Chuck Mcculloch, Miriam Kuppermann, Deborah Karasek,
Presenting Author: Vincenzo Cornacchione*
Background: Rising income inequality in the United States highlights the need for interventions targeting economic and social conditions among low-income pregnant people. Enhanced prenatal care programs may complement or increase access to public assistance by addressing social determinants of health (SDOH), although enhancements and types of support vary across delivery models. We compared two types of enhanced models: enhanced group prenatal care (eGPC) and enhanced individual prenatal care (eIPC).
Objective: To determine whether randomization to eGPC improved pregnant individuals’ food and financial security compared with eIPC.
Methods: We used longitudinal data from the Engaging Mothers and Babies–Reimagining Antenatal Care for Everyone (EMBRACE) study, a randomized comparative effectiveness trial including low-income and primarily Latine pregnant individuals in California’s Central Valley. We used mixed effects logistic and linear models to estimate associations between eGPC randomization and two self-reported outcomes at 3rd trimester (3T) and 3-month postpartum, compared to eIPC randomization. Outcomes included a dichotomous measure of household food security based on the Household Food Security Scale, and a dichotomous and continuous measure of financial security based on the CFPB Financial Well-Being Scale. Models were adjusted for time, monthly household income at baseline, and language preferences.
Results: 678 participants were randomized into eIPC (n = 371) and eGPC (n = 298). We did not observe significant differences between eGPC and food security, compared to eIPC [3rd trimester aOR = 1.44 (95% CI: 0.67, 3.07)]. Participants randomized into eGPC had higher odds of very low to medium-low financial well-being compared to those in eIPC [(3rd trimester aOR = 2.26 (95% CI: 1.08, 4.70)].
Conclusion: Based on the data from the EMBRACE study, we saw few differences in food security and financial well-being between participants of both models. While delivery may not determine important SDOH outcomes, future research should examine specific pathways to improving SDOH through enhanced prenatal care offerings.