Perinatal anxiety is common during pregnancy and can lead to adverse outcomes for mothers and newborns. Education programs focusing on childbirth and health literacy have shown promise in reducing pregnancy-related anxiety. However, these programs face challenges such as transportation and childcare issues, making access difficult for some patients, particularly those at high risk. Therefore, whether an online childbirth education course can effectively improve outcomes in this high-risk population remains unclear.
This study aimed to compare the effects of an interactive online childbirth education platform called Birthly with usual prenatal education on anxiety levels, emergency healthcare utilization, and delivery outcomes in high-risk pregnancies. A randomized trial involving patients with high-risk pregnancies (due to medical or mental health disorders) who were nulliparous, English-speaking, and had internet access.
Participants were enrolled before 20 weeks of gestation from two urban clinics serving under-resourced patients. The intervention group received access to Birthly, which consisted of three interactive courses (prenatal boot camp, breastfeeding, newborn care) and an online community moderated by clinicians. The control group received the usual prenatal education alone.
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Pregnancy-related Anxiety Scale questionnaires were completed randomly and at 34 to 40 weeks. The primary outcome measured was the Pregnancy-related Anxiety Scale score in the third trimester. Secondary outcomes included changes in anxiety scores, unscheduled emergency visits, delivery outcomes, and postpartum outcomes.
Ninety patients were randomized, with no differences in demographics or baseline anxiety scores. The majority of patients identified as Black and had public insurance. Over 60% of patients in the intervention group completed at least one Birthly course.
Patients in the intervention group had significantly lower anxiety scores in the third trimester than those in the control group. The intervention group also had fewer unscheduled emergency visits. There were no differences in delivery outcomes, although breastfeeding rates were higher in the intervention group. Patients who received the intervention reported higher satisfaction with their childbirth education.
The findings suggest that an interactive online childbirth education platform can reduce pregnancy-related anxiety, decrease emergency healthcare utilization, and improve satisfaction among high-risk patients. This online approach can potentially provide valuable support and education to this vulnerable population.
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