Video-Based Antenatal Care Education Helped Parents of Preemies

Pregnant patients who received educational video content via text messages about antenatal care for babies born preterm were more prepared for maternal and infant health decisions, without increased anxiety, a randomized trial showed.

Of 120 participants, those who were enrolled in the Preemie Prep for Parents (P3) program scored higher on knowledge of long-term outcomes at 25 weeks using the Parent Prematurity Knowledge Questionnaire compared with the control group (88.5% vs 73.2%, respectively, P<0.001), reported Mir A. Basir, MD, of the Medical College of Wisconsin in Milwaukee, and colleagues.

Additionally, P3 participants reported being “significantly more prepared” for neonatal resuscitation decision making, with scores of 76.0 versus 52.3 (range 0-100) on the Preparation for Decision Making Scale at 25 weeks, they said in JAMA Pediatrics.

Anxiety scores for both groups were not significantly different at this time, with mean Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scores of 53.8 versus 54.0, respectively.

Despite the fact that half of mothers who deliver preterm infants are diagnosed with risk factors prior to delivery, “education on preterm birth and medical decision-making is not consistently provided to them until the delivery hospitalization due to clinicians’ concern that it will increase parental anxiety,” Basir and team wrote.

Infants born preterm experience more death and disability than those born at term.

About 10% of infants born in the U.S. are preterm, and 38.7% of study participants delivered preterm, which the authors suggested indicates successful targeting.

Ultimately, Basir and colleagues concluded that “[a]nticipatory preterm birth education in early pregnancy may empower parents with known preterm birth risk factors to participate in medical care decisions in the event of preterm birth.”

In an accompanying editorial, Amelia Q. Schuyler, MD, MPH, and Waldemar A. Carlo, MD, both of the University of Alabama at Birmingham, noted that previous studies found that prematurity counseling was conducted in 69% of cases where the mother was in premature labor, and only 16% were counseled before labor.

They argued that “insufficient counseling leaves families unprepared to participate in shared medical decisions that can affect neonatal outcomes,” and that education prior to delivery prepares families before “making informed but difficult decisions regarding resuscitation in the periviable period and further care during NICU [neonatal intensive care unit] hospitalizations.”

Matthew Hoffman, MD, MPH, of Christiana Care in Newark, Delaware, who wasn’t involved in the study, told MedPage Today that the study was well designed; however, its “greatest limitation is that the intervention was mostly trialed in a predominantly college-educated white population and whether the same benefits may be realized in other populations and cultural contexts remains unclear.”

“This study demonstrates that parents can get a solid foundation to make these decisions through virtual education,” he said. “These decisions are often made in incredibly stressful moments of a patient’s life. Having a solid foundation of knowledge allows doctors and patients to focus on shared decision making rather than building the foundation of knowledge upon which these decisions are made.”

For this study, 120 participants were recruited in person (before the pandemic began) and then via phone from February 2020 through April 2021 from an academic medical center near Milwaukee. All patients had a risk factor for preterm birth, such as a short cervix, multifetal gestation, history of spontaneous preterm birth, preeclampsia, chronic hypertension, diabetes requiring medications, and intrauterine growth restriction. They all were between 16 and 21 weeks’ gestation at enrollment, mean patient age was 32.5 years, and 74.2% were white.

The participants were randomized 1:1 to receive the intervention of P3 content, consisting of texted links to 51 short animated videos targeted to specific gestational ages, beginning at 18 weeks’ gestation, or to the control group, who received links to resources and educational content from the American College of Obstetricians and Gynecologists (ACOG) website.

Those in the P3 group watched between 33.3% and 88.3% of the videos sent out; videos about earlier stages in pregnancy were viewed more, but those who watched more videos also had higher knowledge scores at 34 weeks’ gestational age.

Basir and team noted a few study limitations, including that their metrics tracked patient knowledge, not decisions or health outcomes. Additionally, ACOG did not grant the researchers access to track participants’ use of the ACOG materials. They recommended that future studies look into health outcomes, as well as specific subgroups most affected by preterm birth.