Amy Picklesimer

Racial differences in C-reactive protein levels during normal pregnancy.

OBJECTIVE The purpose of this study was to characterize serum C-reactive protein (CRP) levels in a diverse population of healthy pregnant women with the use of a high sensitivity assay. STUDY DESIGN We conducted a cross-sectional analysis of a cohort of 775 pregnant women. CRP was measured on serum specimens that were drawn at < 26 weeks of gestation with highly sensitive enzyme-linked immunosorbent assay kits. RESULTS Median CRP was 4.8 mg/L (interquartile range, 0.63-15.7). Black women had higher median CRP values than did white women (7.68 vs 2.59 mg/L; P < .001). Black women demonstrated higher levels of CRP, even after the data were controlled for known confounding factors such as smoking and maternal weight. CONCLUSION Pregnancy is an inflammatory stressor. The cause of racial differences is unclear but may be important for understanding racial disparities in the incidence of inflammatory disorders such as preterm labor and preeclampsia.

Qualitative Comparison of Women's Perspectives on the Functions and Benefits of Group and Individual Prenatal Care.

INTRODUCTION Womens definitions and experiences of the functions and benefits of their routine prenatal care are largely absent from research and public discourse on prenatal care outcomes. This qualitative study aimed to develop a framework of womens prenatal care experiences by comparing the experiences of women in individual and group prenatal care. METHODS We conducted serial qualitative interviews with racially diverse low-income women receiving individual prenatal care (n = 14) or group prenatal care (n = 15) through pregnancy and the early postpartum period. We completed 42 second-trimester, 48 third-trimester, and 44 postpartum interviews. Using grounded theory, the semistructured interviews were coded for themes, and the themes were integrated into an explanatory framework of prenatal care functions and benefits. RESULTS Individual and group participants described similar benefits in 3 prenatal care functions: confirming health, preventing and monitoring medical complications, and building supportive provider relationships. For the fourth function, educating and preparing, group care participants experienced more benefits and different benefits. The benefits for group participants were enhanced by the supportive group environment. Group participants described greater positive influences on stress, confidence, knowledge, motivation, informed decision making, and health care engagement. DISCUSSION Whereas pregnant women want to maximize their probability of having a healthy newborn, other prenatal care outcomes are also important: reducing pregnancy-related stress; developing confidence and knowledge for improving health; preparing for labor, birth, and newborn care; and having supportive relationships. Group prenatal care may be more effective in attaining these outcomes. Achieving these outcomes is increasingly relevant in health care systems prioritizing woman-centered care and improved birth outcomes. How to achieve them should be part of policy development and research.