731 - The effect of postpartum care in the NICU (PeliCaN) on maternal health related quality of life

Publication Number: 1708.731

Adina Harris, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Niesha D.. Darden, Children's Hospital of Philadelphia, Wayne, PA, United States; Maggie Power, University of Pennsylvania, Philadelphia, PA, United States; Laura Walker, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rachel F. Ledyard, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Celeste Durnwald, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Katey E. Mari, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Heather Burris, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Mothers of infants in neonatal intensive care units (NICUs) have more comorbidities and worse long-term health outcomes than parents of well newborns. Common health concerns among NICU parents include mental health and pain, likely contributing to lower health-related quality of life (HRQOL). While comprehensive postpartum care may address many health concerns, approximately one in three NICU parents do not attend a postpartum visit. Whether bringing postpartum care to the NICU can improve health, and thus HRQOL, among this high-risk population is unknown.

Objective: To determine whether doula-coordinated, certified nurse midwife (CNM) postpartum care in the NICU (PeliCaN) improves maternal HRQOL at 6 months postpartum.

Design/Methods: Secondary analysis of PeliCaN, a pilot randomized controlled trial in a Philadelphia level-3 NICU (2022-2023). Mothers of infants < 34 weeks' gestation and < 2 weeks of age with a minimum anticipated NICU stay of >1 week were eligible. The intervention group (n=20) received doula-coordinated, CNM-delivered postpartum care, and the control group received usual care (n=17). There were 17 intervention and 17 control participants who completed 6-month follow-up surveys, including the HRQOL-14 validated scale. HRQOL assessed the number of physically and mentally unhealthy days, healthy days symptoms, and activity limitations over the last 30 days. A composite unhealthy days score was calculated by summing the total number of physically and mentally unhealthy days. Linear and logistic regression models for the continuous number of unhealthy days and any unhealthy days, respectively, adjusted for age and parity determined the effect of PeliCaN on HRQOL at 6 months postpartum.

Results: Characteristics of intervention and control participants were similar (Table 1). Intervention, compared to control participants, reported a non-significantly lower median [IQR] number of overall unhealthy days (5 [0, 15] vs. 9 [2, 21], P=0.26), similar mentally unhealthy days (5 [0, 12] vs 3 [0, 10], P=0.92), and fewer physically unhealthy days (0 [0, 3], 2 [0, 7], P=0.20) (Table 2). Results from linear and logistic regression models were similar (Figure 1). With respect to healthy days symptoms, intervention participants had non-significantly lower odds of reporting any days in pain (aOR 0.27, 95% CI: 0.06, 1.34).

Conclusion(s): Postpartum doula-coordinated, CNM-delivered postpartum care may improve HRQOL for parents of infants in the NICU, but larger studies, across more settings are required.

Table 1. Characteristics among Postpartum Care in the NICU (PeliCaN) intervention and control group participants.


Table 2. Health Related Quality of Life (HRQOL-14) among Postpartum Care in the NICU (PeliCaN) intervention and control group participants.


Figure 1. Health related quality of life (HRQOL) 6 months postpartum among participants of the Postpartum Care in the NICU (PeliCaN) pilot randomized controlled trial (n=34).
Panel A shows odds ratios of any unhealthy days among intervention compared to control participants. Panel B shows differences in number of unhealthy days among intervention compared to control participants.