Evaluation of a program to prevent prematurity and low birth-weight deliveries in a low income population

Background: The March of Dimes-funded Prematurity Prevention Partnership (PPP) holistically approached improving birth outcomes by considering psychosocial and medical risk factors in developing individualized service plans for participants. Palmetto Healthy Start (PHS) Resource Mothers and Social Workers implemented these plans, providing supportive interactions and referrals. Outcome evaluation focused on assessing program effectiveness in reducing the incidence of prematurity and low birth weight [LBW].

Methods: We compared PHS/PPP prematurity and LBW ratios across time as well as compared PHS/PPP ratios to county and state ratios for 2003-2005, using t-tests and X2 for comparisons. We examined overall ratios and African-American-specific ratios.

Results: From June 2003-August 2006, LBW and prematurity ratios have dramatically declined for PHS/PPP participants (N=1,326) from 26.5% of LBW births and 24.5% premature (< 37 weeks) to 9.3% LBW and 13.1% premature. This is a 65% decline for LBW and a 47% decline for prematurity in this predominately African-American (85%) population. Over the same period, ratios for the county and state were rising. Births at less than < 32 weeks gestation declined 80% for African-American PHS/PPP participants (from 12.24% to 2.38%) and stayed around 4% for African-Americans in the county and state over the same period.

Conclusion: The PPP emphasized prematurity prevention for PHS staff and participants; over time there has been a substantial reduction in LBW and prematurity for participants, which is not seen in the general state or county pregnant population. PPP appears to have had a profound effect on improving birth outcomes in this high-risk population.