Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Applied Health Research and Evaluation

Committee Chair/Advisor

Kathleen Cartmell and Sarah Griffin

Committee Member

Moonseong Heo

Committee Member

Amy Crockett


In the United States metrics of perinatal health lag far behind peer countries and is characterized by stark disparities. The studies that make up this dissertation seek to elucidate factors influencing perinatal health.

The first and second chapters provide an introduction and extensive review of the literature of factors contributing to perinatal health with specific focus on discrimination and perinatal health; group prenatal care and digital pregnancy health information. The third chapter introduces the methodology to be used by each of the following studies. Subsequent chapters are formatted as individual manuscripts, each presenting background, methodology, results, and discussion.

The fourth chapter (Manuscript 1) sought to explore pregnant persons intersectional experience of discrimination and the association with adverse perinatal health outcomes. This study was a secondary analysis of data collected in a randomized controlled trial of pregnant persons at a single practice (CRADLE study). Latent class analysis was used to identify distinct subgroups of discrimination experience based on patterns of response to Everyday Discrimination Scale items and between subgroup differences in rate of adverse perinatal health outcomes examined utilizing a BCH three-step approach. Four discrimination subgroups were identified among racial and ethnic groups. The general discrimination latent class was associated with elevated risk of postpartum depression symptoms (among Black and White participants) and low infant birthweight (among White participants) relative to the no discrimination latent class. No significant subgroup differences were observed among Hispanic participants. Findings demonstrate the importance of intersectional discrimination exposure in shaping perinatal health.

The fifth chapter (Manuscript 2) applied a concurrent mixed methods approach in the examination of patient characteristics associated with group prenatal care and the exploration of patient experiences in group compared to individual prenatal care. This study was a secondary analysis of data collected in the CRADLE study, as well as patient interviews collected in a coordinated process evaluation. The association of patient sociodemographic, psychosocial and health characteristics with group prenatal care session attendance were examined using zero-inflated poison regression models. Thematic analysis of patient interviews was conducted. Varied patient characteristics were found to be associated with session attendance. Group prenatal care was identified to offer alternative opportunities for education, engagement, and peer support. Findings offer insight into model modifications, recruitment, and retention strategies.

The sixth chapter (Manuscript 3) utilized topic modeling to describe topics of discussion in online pregnancy forums. Data was gathered from three active online pregnancy forums for a one-year period. Discussion threads were processed, converted to a document term matrix and Latent Dirichlet Allocation performed. Forty-six percent of threads were determined to be health related. The largest health-related topic categories included fertility, planning for delivery, miscarriage and pregnancy symptoms. Findings offer insight into dominant health related topics being discussed among online peer communities, potentially reflecting unmet information needs during pregnancy.

Author ORCID Identifier




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