Women at Risk of Preterm Birth Benefit from Early Outpatient Counseling on Prematurity

Study among first to examine antenatal counseling in an outpatient setting

Innovations in Pediatrics | Summer 2021

Providing pregnant women at risk of preterm delivery with early, targeted antenatal counseling on prematurity in an outpatient setting increases their knowledge and does not lead to increased anxiety. That’s according to a recent randomized controlled trial conducted at UH Rainbow Babies & Children’s Hospital.

Moira Crowley MD

This study is one of the first to evaluate the benefits of providing standardized antenatal counseling of prematurity in an outpatient setting, says co-author and UH Rainbow neonatologist Moira Crowley, MD. However, she adds, it’s an approach that is needed to better serve patients and their families. A typical antenatal counseling session on prematurity, she says, is often done in the acute setting of a threatened preterm delivery, when time may be limited and emotions and stress may be running high.

“Usually neonatologists are providing families with education on prematurity in an acute setting, often on the labor and delivery floor when the family is imminently expecting to deliver a preterm infant,” she says. “During this time the mother may be in active labor or being treated with medications which may alter her ability to truly understand all that is being discussed. Thus, providing this information in an outpatient, less acute setting could improve parental knowledge, satisfaction and anxiety with regards to possible preterm birth.”

“When surveyed about their experiences with typical antenatal counseling, parents report feeling overwhelmed and powerless,” Dr. Crowley adds. “And in some studies, parents report the desire for counseling as soon as the pregnancy is deemed high risk in order to be better informed and prepared for a preterm delivery.”

That said, Dr. Crowley says there was the question of whether providing early antenatal counseling on prematurity outside of the acute setting would increase anxiety for pregnant women. Study results show it did not. When surveyed about their anxiety after the counseling session, the pregnant women receiving the targeted counseling and those receiving standard counseling at a MFM visit posted similar scores.

“We were happy that it didn't seem to add any undue stress to the family,” Dr. Crowley says. “It gives our field, both OB MFM and neonatology, more confidence that you can start talking about these things earlier on and not adding to parental stress during the pregnancy.”

For the study, the UH Rainbow research team randomly assigned 38 pregnant women to the targeted intervention of early counseling of prematurity and 38 to standard counseling by MFM providers. Only women from 22 0/7 to 34 6/7 weeks gestation were eligible to participate. The intervention group received standardized written (paper and graphic) and verbal information regarding prematurity, associated complications, survival statistics, breastfeeding, how to prepare for a possible preterm delivery and how to reduce their risk of having a preterm delivery – the latter two topics having been suggested by former NICU parents on the UH Rainbow Parent Partnership Council. This information was delivered by a single member of the study team to ensure consistency.

Going forward, Dr. Crowley says she hopes to build on the results of this pilot study to continue to enhance the care provided to patients and families coping with a possible preterm birth.

“This was a pilot study that was able to show that early, targeted antenatal counseling provided to families experiencing a possible preterm delivery improved parental knowledge and satisfaction without leading to increased anxiety,” she says. “Some of the tools that were used in this study could be a method used to provide standardized antenatal counseling in the outpatient setting. Further work is needed to evaluate the benefits of early enhanced antenatal counseling on long-term/sustained knowledge, improvement in compliance with medical recommendations and longer-term parental anxiety. However, given the challenges that exist with counseling in the acute setting of threatened preterm delivery, this novel approach may be a valuable addition to routine prenatal care for at risk pregnancies.”

For more information about this study, please email Peds.Innovations@UHhhospitals.org.

Contributing Expert:

Moira Crowley, MD
Director, Fetal Consultative Services
Director, Neonatal ECMO
Co-Medical Director, Neonatal Intensive Care Unit
UH Rainbow Babies & Children's Hospital
Associate Professor
Case Western Reserve University School of Medicine