A randomized trial of augmented prenatal care for multiple-risk, medicaid-eligible African American women

Objectives. This project investigated whether augmented prenatal care for h igh-risk African American women would improve pregnancy outcomes and patien ts' knowledge of risks, satisfaction with care, and behavior. Methods. The women enrolled were African American, were eligible for Medica id, had scored 10 or higher on a risk assessment scale, were 16 years or ol der, and had no major medical complications. They were randomly assigned to augmented care (n=318) or usual cue (n=301). Augmented care included educa tionally oriented peer groups, additional appointments, extended time with clinicians, and other supports. Results. Women in augmented care rated their care as more helpful, knew mor e about their risk conditions, and spent more time with their nurse-provide rs than did women in usual care. More smokers in augmented care quit smokin g. Pregnancy outcomes did not differ significantly between the groups; howe ver, among patients in augmented care, rates of preterm births were lower a nd cesarean deliveries and stays in neonatal intensive care units occurred in smaller proportions. Both groups had lower-than-predicted rates of low b irthweight. Conclusions. High-quality prenatal care, emphasizing education, health prom otion, and social support, significantly increased women's satisfaction, kn owledge of risk conditions, and perceived mastery in their lives, but it di d not reduce low birthweight.