Universal psychosocial screening and adverse pregnancy outcomes in an academic obstetric clinic

OBJECTIVE: To test the hypothesis that women screened for psychosocial factors, including partner abuse, as recommended by the American College of Obstetricians and Gynecologists would have higher neonatal birth weight, longer gestational age at delivery, higher Apgar scores, and fewer maternal complications.

METHODS: We evaluated a universal psychosocial screening intervention using a retrospective cohort (n=881 prenatal care patients). Pregnancy outcomes among patients screened beginning in 2008 (n=464) were compared with outcomes among women receiving care before universal screening was implemented (n=417). Data were obtained from medical records between 2007 and 2009. Multivariable logistic regression and analysis of covariance were used to estimate the association between screening and pregnancy outcomes among singleton births adjusting for confounders (prior preterm births, insurance, and mode of delivery).

RESULTS: Screened women were less likely than women not universally screened to have low birth weight neonates (4.5% of screened, 10.3% of unscreened; adjusted odds ratio [OR] 0.41, 95% confidence interval [CI] 0.23-0.73), preterm births (9.9% of screened, 14.9% of unscreened; adjusted OR 0.62, 95% CI 0.41-0.96), and any maternal complication (30.0% of screened, 41.2% of unscreened; adjusted OR 0.67, 95% CI 0.50-0.88). Newborn Apgar scores were higher (P=.01) among screened relative to unscreened mothers.

CONCLUSION: Our results provide evidence that universal screening was associated with improved pregnancy outcomes.

LEVEL OF EVIDENCE: II.