Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial.

Mie G De Wolff,Ann Tabor,Marianne Johansen,Susanne Rosthøj,Ane L Rom,Hanne K Hegaard,Julie Midtgaard

doi:10.3390/ijerph18157875

Abstract

The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.

Highlights

Worldwide the population of pregnant women living with chronic medical conditions (CMC) is increasing [1,2,3], and in Denmark, the current prevalence is estimated to be16–21% of all childbearing women [2,4]
Women in the ChroPreg group had 0.1% lower length of hospital stay (LOS) than women in the Standard Care group
In this randomized controlled trial, we found no evidence to support that a midwiferycoordinated maternity care intervention could reduce the total LOS for childbearing women with CMC

Summary

Introduction

Worldwide the population of pregnant women living with chronic medical conditions (CMC) is increasing [1,2,3], and in Denmark, the current prevalence is estimated to be. 16–21% of all childbearing women [2,4]. The reason for this rise in CMCs among pregnant women is multifactorial [1,2]. An enhanced registration of diagnoses and awareness of specific conditions, better treatment options (including medications), fertility treatment, Int. J.

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