Date of Award
Doctor of Philosophy in Nursing (PhD)
Diane Wardell, PhD
Cathy L. Rozmus, PhD
Judy Levison, M.D.
Background: For women living with HIV (WLWH), managing HIV and their pregnancy can be challenging. WLWH have been identified at risk for lower adherence to prenatal care, increased maternal HIV Plasma RNA levels, decreased newborn gestational age, and newborn birth weight. Improved outcomes have been found with group prenatal care. Maternal and newborn outcomes for WLWH and their newborns in group prenatal care compared to WLWH and their newborns in individual care have not been evaluated.
Purpose: The aims of this study were to evaluate group differences between WLWH who attended individual prenatal care appointments (IC) compared to WLWH who attended the HIV-adapted CenteringPregnancy® Program (CP-H) for (1) adequacy of prenatal care utilization, (2) maternal plasma HIV RNA levels, (3) newborn gestational age, and (4) newborn birth weight.
Methods: A secondary data analysis using a retrospective group comparison review was
conducted from data collected for the Baylor College of Medicine HIV Perinatal Study. The total sample size was 233. Univariate analyses of Chi-square of Independence and Fisher’s Exact test were completed to identify confounding variables. Univariate analyses for outcome variables included a Mann Whitney U test for the APNCU index score, a Chi-Square of Independence test for the maternal viral load levels, and t-tests and Mann Whitney U tests for newborn gestational age and birth weight. As one confounding variable was identified, an analysis of covariance was also completed for newborn gestational age and birth weight.
Results: Previous preterm birth was the only confounding variable to be statistically significant between the IC and the CP-H groups. Significant differences were found for improved outcomes in the CP-H group for an undetectable viral load (p = .011), newborn gestational age (p = .013), and newborn birth weight (p = .002). When controlling for previous preterm birth, statistical significance was found for newborn gestational age (p = .014) and newborn birth weight (p = .003). The mean and median gestational age was higher (M = 38.891 weeks; Mdn = 39.143 weeks) in the CP-H group compared to the IC group (M = 38.005 weeks; Mdn = 38.571 weeks). The mean and median newborn birth weight was higher in the CP-H group (M = 3.219 kilograms; Mdn = 3.144 kilograms) compared to the IC group (M = 2.912 kilograms; Mdn = 2.892 kilograms)
Conclusion: The APNCU index scores for both groups provide updated information for WLWH. The improvements in undetectable viral load levels for WLWH in CP-H also provided newer information related for WLWH, while increased newborn gestational age and increased birth weight for the CP-H group were consistent with improvements seen in other studies and provided new information regarding group prenatal care for WLWH.
Behr, Jodi, "Maternal and Newborn Outcomes for Women Living with HIV in Adapted Group Prenatal Care" (2020). Dissertations (Open Access). 47.
CenteringPregnancy®, Women Living with HIV, Newborns