Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE) Study (EMBRACE)

This is a randomized comparative effectiveness study of two forms of enhanced prenatal care among 2,600 Medi-Cal eligible pregnant women in Fresno, California. The goal is to see whether group prenatal care with wrap around services versus individual prenatal care supplemented by services covered by the California Department of Public Health Comprehensive Perinatal Services Program (CPSP) results in lower rates of preterm birth, less depression and anxiety, and more respectful and greater satisfaction with prenatal care.

Premature Birth, Pregnancy Preterm, Prenatal Stress, Depression, Anxiety, Depression, Postpartum, Satisfaction, Patient, Health Problems in Pregnancy

Premature Birth, Group Prenatal Care, Respectful Care, Patient Satisfaction, Prenatal Depression and Anxiety, Low Income, Health Inequity, Prenatal Care

Glow! is an enhanced group prenatal care model that offers co-located social services provided by established community programs with independent funding streams targeting low-income families. The Glow! group prenatal care model pairs a trained facilitator with a licensed prenatal care practitioner from a practice site to provide billable prenatal care to the practice's own patients. Over the course of 8-10 sessions, 10-12 women (within a 6- week gestational age range) receive prenatal medical care, risk assessments, and social support, and gain knowledge and skills related to pregnancy, birth, and parenting.

Comprehensive Perinatal Services Program (CPSP) is a state-funded program for Medi-Cal eligible families to receive enhanced care and service coordination. Participants assigned to CPSP individual care may participate in the CPSP assessments with a Comprehensive Perinatal Health Worker at their prenatal care site, where individual prenatal care will be provided

Whether the participant had a baby born less than 37 weeks gestation, as noted in the participant's medical record.

Changes in depressive symptom severity from baseline to postpartum. Assessed using the Patient Health Questionnaire (PHQ-9) developed by Kroenke et al. (2001), administered in-person at baseline and during telephone interview at three months postpartum.

Extent to which the participant feels that the prenatal care they received was respectful. Assessed using the Mothers on Respect Index (MORi) developed by Vedam et al. (2017), administered during telephone interview or in-person at third trimester and three months postpartum.

The gestation age at which the baby was born (number of weeks), as noted in the participant's medical record.

Changes in anxiety symptom severity from baseline to postpartum. Assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale developed by Spitzer et al. (2006), administered in-person at baseline and during telephone interview at three months postpartum.

Extent to which the participant feels satisfied with the prenatal care they received. Assessed using the Prenatal Care Satisfaction (PSQ) Scale developed by Raube et al. (1998), administered during telephone interview or in-person interview at third trimester and three months postpartum.

Inclusion Criteria: Between 8 and 20 weeks gestation at enrollment Eligible for Medi-Cal (at or below 213% of the federal poverty level) Speak English or Spanish Exclusion Criteria: Unavailable to attend group prenatal care sessions Not planning to continue prenatal care with site provider Cannot legally consent to participate in the study

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Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.

Raube K, Handler A, Rosenberg D. Measuring satisfaction among low-income women: a prenatal care questionnaire. Matern Child Health J. 1998 Mar;2(1):25-33. doi: 10.1023/a:1021841508698.

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