Clemson, Greenville doctor seek answers to preterm births

Ever since starting a group prenatal care program, Dr. Amy Crockett has seen a reduction in preterm births among women enrolled.

Now she and her team, along with partners from Clemson University, are embarking on a study to determine whether it’s the program that’s made the difference or some other factor.

“In South Carolina, we have a high rate of preterm birth ... so seeing improvements was really exciting for us,” said Crockett, who is a maternal-fetal medicine specialist with Greenville Health System's OB/GYN Center. “We believe there’s something really happening here.”

CenteringPregnancy is a model of care that provides enhanced education, support and health care for a group of women who are due to have babies at the same time.

While the first visit is the same as traditional prenatal care — a physical and risk assessment — it’s followed by 10 two-hour visits over six months that include care by a nurse practitioner or nurse midwife, group education and discussion of topics such as preparation for labor, breastfeeding and preparing to be a parent.

There’s also time for socializing, which helps the moms to be feel less afraid and alone because they're sharing the experience with others in the same situation.

Eight weeks ago, Kelly Smith had her son, Brooks, through the program, calling it a vastly different experience than her first pregnancy, which she described as impersonal and cold.

“Going to a place like that, you never know who you’re going to see, what doctor you’re going to have. You were just a number there instead of a name and it’s kind of stressful, especially ... if you don’t feel comfortable talking to a doctor you don’t know,” said the 35-year-old Greenville restaurant manager.

“With Centering, you see the same people every time,” she said. “They know you on an individual level. And everybody makes you feel so warm and welcome.”

Reassurance and support

The reassurance and support she got from the other women eased the insecurity and anxiety too, she said. By sharing what they were going through with one another, they became friends.

“You’re not just sitting there by yourself,” she said. “And there were three of us who had babies on the same day and were in the hospital together. We keep in contact with each other, watch our babies grow up together and we’re planning a reunion.”

CenteringPregnancy has reduced the rate of preterm births — those before 37 weeks — by 47 percent and narrowed the racial disparity in those births as well, Crockett said.

The rate in 2014 was 10.8 percent overall, compared with the U.S. rate of 9.6 percent, she said. The rate for black women is 13.9 percent compared to the rate for white women — 9.5 percent, she said, while Hispanic women have the lowest rate at 8.9 percent.

“Preterm birth is such a prevalent problem," Crockett told The Greenville News, "and it’s so critically important because when babies come too soon, they have disadvantages throughout life — health problems, learning problems — that limit their employment prospects and can cause chronic lifelong conditions.”

The program, which began in 2008, leads to better care for women and healthier babies, better preparation for childbirth and motherhood, higher rates of breastfeeding, and increased family planning, she said.

Women who go through CenteringPregnancy also have fewer low birthweight babies and their infants end up in the Neonatal Intensive Care Unit less often as well, Crockett said.

And that translates into savings — $29,627 for each low birthweight baby, $22,667 for each preterm birth, and $27,249 for each NICU admission through the baby’s first year of life.

“If we can get more babies born on time, we have the capacity to impact the entire state beyond the domain of health care,” she said. “This represents savings not only to the health-care system, but also a huge positive impact on South Carolina’s families and infants.”

Finding answers

While Crockett believes the program is responsible for the improved outcomes, the research is designed to find out whether other factors could be at play.

For instance, she said, some kind of bias. Are the women who choose CenteringPregnancy more motivated about prenatal care or more engaged in their own health care? Or are there situations during pregnancy that play a role, such as anxiety, depression, or the relationship with the baby’s father?

So the study will look at all those measures as well as medical history and compare the women in randomized groups, she said.

The research will be funded by a $2.7 million grant from the National Institutes of Health designed to support research that addresses significant health issues and provides innovative solutions, said said Liwei Chen, assistant professor of public health sciences and co-principal investigator on the study with Crockett.

It will recruit 3,000 women over the next three years.

“We have observed a lot of potential benefit for moms and babies in the group prenatal care model ... but this trial will be the gold standard to test whether this model is better than individual prenatal care,” she said. “Our project will also demonstrate whether CenteringPregnancy has additional benefits for African-American women and their babies.”

While African-American preterm birth rates are higher, the reasons for the disparity are unknown. It’s hoped the research will provide an answer and thus help to reduce the disparity, she said.

The grant also offers opportunities to train graduate students, medical interns and residents on conducting translational research and improving quality of care to patients, she said.

The project is a good example of how a research institute and a hospital can work together to win an important grant to fund valuable research that has the potential to change the way prenatal care is provided in the U.S., Chen said.