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Advisory Committee Chair

Beverly Mulvihill

Advisory Committee Members

Russell Kirby

Gerald McGwin

Judith Skelton

Document Type

Dissertation

Date of Award

2012

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

CenteringPregnancySmiles [TM] (CPS), a group prenatal care program with an oral health component, has demonstrated promising results in urban communities with primarily low-income minority women. This study examined three questions: 1) Do women who participate in CPS have better birth outcomes than those who participate in traditional prenatal care, even after adjusting for maternal characteristics and risk factors? 2) Is level of exposure to the intervention associated with improved birth outcomes? 3) Do women with dental infection have an increased risk of poor birth outcomes? Data were abstracted from medical records and birth certificates. Birth outcomes for women enrolled in Medicaid who received traditional prenatal care (2005-2007; n=1,128) and women enrolled in CPS (2006-2007; n=294) were compared. This analysis included bivariate and multivariable logistic regression to examine late preterm (34-36 weeks) and early term births (37-38 weeks), low birth weight (<2,500 grams) and small for gestational age (SGA). Outcomes were compared for women who attended less than 6 CPS sessions and 6 or more sessions, controlling for race/ethnicity, maternal age, parity, diabetes, hypertension, pre-pregnancy BMI, tobacco, previous preterm birth and adequacy of prenatal care. Women who attended any CPS visits had a reduced risk of late preterm (OR=0.446; 95% CI: 0.237, 0.841) and early term birth (OR=0.538; 95% CI: 0.368, 0.786) compared to women who received traditional care. Women who attended 6 or more sessions had significantly decreased odds of a late preterm birth (OR=0.240, 95% CI: 0.101, 0.575) and of an early term delivery (OR=0.430, 95% CI: 0.277, 0.667) compared to those who received traditional care. No reduction was observed for low birth weight or SGA births. No association was found between oral infection and poor birth outcomes. CenteringPregnancySmiles demonstrates promise in reducing late preterm and early term births for high-risk women in rural communities. Group prenatal care may more effectively provide low-income women with prenatal education and social support, resulting in improved birth outcomes and intangible future benefits for both mother and infant.

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