A Retrospective Analysis of Pregnancy and Birth Outcomes Associated with a Prenatal Care Outreach Program for Hispanic Women in Rural Tennessee

INTRODUCTION: The importance of prenatal care is a well-established principle in the field of obstetric care. Inconsistent, poor and/or inadequate prenatal care is associated with a wide range of poor health outcomes including, pre-term labor, low-birth weight infants and maternal mortality. Hispanic women, specifically migrant/seasonal farmworkers, face a variety of barriers to early and effective prenatal care including: language barriers, poverty, transportation and frequent mobility. Northeast Tennessee has grown to include a robust Hispanic community. Rural Medical Services (RMS), a provider of primary care in rural Tennessee, has developed and implemented a prenatal care outreach program for the local Hispanic population. Through this program Hispanic pregnant women receive educational and clinical services ranging from prenatal education materials and at-home visits to translation services and Lamaze training. The purpose of the current study was to determine the impact of RMS’ prenatal outreach program on the birth outcomes of regional Hispanic mothers. METHODS: A retrospective medical file review using RMS electronic medical records as well as prenatal outreach program documents, including all patients that gave birth during 2013, was conducted. Independent variables included the mother’s age and ethnicity, identification as migrant/seasonal worker, weeks of gestation at first prenatal visit, number of prenatal visits, and number of prenatal outreach visits/contacts. Dependent variables included infant’s gestational age at birth (weeks), infant’s birth weight (oz.), and APGAR scores. RESULTS: In total, 213 women received care for pregnancies with expected due dates in 2013. Of those, birth outcomes data were available for 180. There was no significant difference in the incidence of low birth weight for infants of non-Hispanic and all Hispanic mothers (9.8% v. 4.3%; p=.14) nor was there a significant difference between Hispanic mothers who did not identify as migrant/seasonal farmworkers and those who did (5.1% v. 3.4%; p=.66). Likewise, there was no significant difference in the incidence of pre-term birth (\u3c37 weeks) between non-Hispanic and Hispanic mothers (12.9% v. 8.5%; p=.35) nor was there a significant difference between Hispanic mothers who did not identify as migrant/seasonal farmworkers and those who did (6.7% v. 10.3%; p=.47). While the number of prenatal visits for Hispanic mothers was significantly correlated with birth weight (r=.35; p\u3c.001) and gestational age at birth (r=.40; p\u3c.001), the number of prenatal outreach visits was not significantly correlated with birth weight (r=.16; p=.08) or (r=.15; p=.10). CONCLUSIONS: The RMS prenatal outreach program has closed the prenatal care disparity gap between their Hispanic and non-Hispanic patients. However, there was no therapeutic advantage to an increased number of outreach visits, indicating RMS could standardize the program with a low frequency of visits