165404 Interpregnancy primary care and social support for African-American women at risk for recurrent very-low-birthweight delivery: A pilot evaluation

Tuesday, November 6, 2007: 9:15 AM

Anne Lang Dunlop, MD, MPH , Department of Family & Preventive Medicine, Emory University School of Medicine, Atlanta, GA
Cynthia Dubin, CNM, FNP, MSN , Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA
B. Denise Raynor, MD , Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA
George W. Bugg, MD, MPH , Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
Brian Schmotzer, MS , Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, GA
Alfred W. Brann, MD , Department of Pediatrics, Emory University School of Medicine, Atlanta, GA

Background.  Very-low-birthweight (VLBW) delivery accounts for the majority of neonatal mortality and the black-white disparity in infant mortality.  The risk of recurrent VLBW is highest for African-Americans of lower socioeconomic status.  This study explores whether the provision of primary health care and social support following a VLBW delivery improves subsequent reproductive health outcomes for low-income, African-American women.    

Methods.  This pilot study of mixed prospective-retrospective cohort design enrolled African-American women who qualified for indigent care and delivered a VLBW infant at a public hospital in Atlanta from November 2003 through March 2004 into the intervention cohort (n1 = 29).  The intervention consisted of coordinated primary health care and social support for 24 months following the VLBW delivery.  A retrospective cohort was assembled from consecutive women meeting the same eligibility criteria who delivered a VLBW infant during July 2001 through June 2002 (n2 = 58).   The number of pregnancies conceived within 18 months of the index VLBW delivery and the number of adverse pregnancy outcomes for each cohort was compared with Poisson regression.

Results.  Women in the control cohort had, on average, 2.57 (95% CI: 1.14 – 5.78) times as many pregnancies within 18 months of the index VLBW delivery and 3.51 (95% CI: 1.04 – 11.73) times as many adverse pregnancy outcomes as women in the intervention cohort.

Conclusions.  This small, pilot study suggests that primary health care and social support for low-income, African-American women following a VLBW delivery may enhance achievement of a subsequent 18-month interpregnancy interval and reduce adverse pregnancy outcomes. 

 

Learning Objectives:
1. Recognize the contribution of very low birth weight (VLBW) delivery to infant mortality in the United States; 2. Identify medical, obstetrical, psychosocial, and behavioral risk factors for a VLBW delivery; 3. Describe elements of an interpregnancy care intervention associated with achievement of an 18-month interpregnancy interval and a reduction in adverse pregnancy outcomes for this pilot study.

Keywords: Primary Care, Social Services

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.