Providing an optimized and emPowered pregnancy for you (P³OPPY) acceptability and feasibility pilot trial

Persistent racial inequities in maternal morbidity and mortality disproportionately affect non-Hispanic Black pregnant women in the United States, particularly those living in socioeconomically deprived communities. Community health worker (CHW) programs and digital health interventions (DHI) show promise for improving perinatal outcomes, yet few randomized trials have evaluated their acceptability or feasibility in high-risk perinatal populations.

To conduct a pilot randomized controlled trial (RCT) to determine the feasibility of randomizing participants in a perinatal intervention trial and ascertain whether participants found the interventions acceptable.

Single-center, parallel RCT including non-Hispanic Black participants, between 16 and 49 years, 8⁰ and 22⁶ weeks gestational age (GA), and residing in resource-poor communities in Alabama, defined as Area Deprivation Index (ADI) 60 to 100. Using a 2-by-2 factorial design, participants were randomly assigned to DHI vs usual care and to CHW vs usual care; providers were blinded. The primary outcome for this pilot was acceptability of the intervention. Secondary outcomes included recruitment feasibility, participant's intervention satisfaction (1-10 scale, 10 highest satisfaction), number of prenatal care (PNC) visits, and clinical outcomes.

Forty participants were successfully recruited and randomized from July to October 2023. Median age, GA at enrollment, and ADI were 29 years, 14 weeks, and 90; 78% were parous, 18% were married, 60% had ≤ a high school diploma, and 80% were publicly insured. Of those randomized to CHW, 18/21 recommended CHW care; of those randomized to DHI, 18/20 recommended DHI care. Participants randomized to CHW were highly satisfied (100% responded 10/10; n=18); DHI participants were also highly satisfied (median satisfaction score 8/10, IQR 7-10, n=18). Participants attended a median 11 PNC visits and delivered at a median GA of 37 weeks; 5 (13%) experienced pregnancy loss and 25% of neonates were admitted to the neonatal intensive care unit.

Participants were successfully recruited and randomized in a perinatal intervention trial and reported high rates of satisfaction with DHI and CHW interventions, lending support for a large RCT powered for key clinical outcomes.