WIC and Preconception Care: A Prematurity Prevention Project

WIC and Preconception Care: A Prematurity Prevention Project, funded by the March of Dimes, is a three year program that provides care coordination services to 120 low-income mothers who have recently delivered preterm and/or low birthweight babies. This project is designed to lessen the risk of having another preterm infant. Services include include screening, health promotion and psycho-social interventions. Based in a WIC Center in Los Angeles, California, these services are being provided to women enrolled in the PHFE-WIC Program in order to optimize their health, support family planning, and maximize their chances for a subsequent full-term healthy pregnancy. The primary objectives of the project are to improve the health status of women who have recently delivered a preterm and/or low birthweight baby, to increase pregnancy intervals and rates of planned pregnancies, thereby reducing the incidence of repeat premature births to low-income women.

In the last decade, the nation has seen a significant rise in the number of infants born preterm. As an example, between 2003 and 2006 the rate of premature births among Los Angeles County WIC participants rose from 5.5% to 6.4%, a startling increase of 16.4%. Closely spaced pregnancies (conception less than 16 months postpartum) are a known risk factor for adverse birth outcomes, and rates of closely spaced pregnancies hover around 19% among the Los Angeles County WIC population. In the face of this increase in premature births, a trend documented nationwide, a focus on “interconception” care is emerging. This period of time between pregnancies is a prime time to improve support services for mothers. Particularly for high-risk women, the goal of interconception services is to provide specific strategies for risk reduction before the next pregnancy. It is not sufficient to wait until a woman becomes pregnant again to address her pregnancy risks – these risks must be addressed prior to pregnancy.

WIC, the Special Supplemental Nutrition Program for Women, Infants and Children, is a USDA-funded food and nutrition education program for pregnant, breastfeeding, and postpartum women, infants and children under the age of five who are low income (up to 185% of poverty) and at nutritional risk. The PHFE-WIC Program (PHFE-WIC) is a 501(c) (3), federally tax-exempt, not-for-profit agency that has been providing WIC services in Los Angeles County for over thirty years and in Orange County for twelve years. By providing eligible participants with healthy foods such as milk, cheese, iron-fortified cereals, juice, eggs, beans and infant formula, PHFE-WIC helps to instill life-long healthy eating habits and prevent nutrition disorders such as anemia, infant mortality and low birth weight.

PHFE-WIC serves approximately 316,000 participants each month and is the largest local agency in the country, serving approximately 4% of the nation's total and 23% of California's total WIC participants. Eighty-one percent of the clients served by PHFE-WIC are Latino, 9% are African-American, 5% are Caucasian, 4% are Asian and <1% are Native American.

This prematurity prevention demonstration project is designed to show that care coordination of high-risk women who receive WIC services will dramatically increase women's chances of a healthy subsequent pregnancy. In Los Angeles County, over 91% of all infants born to low-income families are served by the WIC Program. Families visit WIC through multiple pregnancies and WIC is one of very few services that low-income women access at least four times a year. Success of this project has local and national implications, as WIC sevrvices are available in every county in the United States.

The evaluation plan for this project includes indentification of both intervention and control WIC Centers. Data are being collected on the premature/low birthweight infant, the mom's health and healthcare, family planning, nutrition and weight/height, smoking and alcohol behaviors and home environment. Multiple survey tools have been tested and designed (in English and Spanish) and are being used to collect data on 120 cases and 120 controls. With these numbers, the impact of multiple covariates are being explored, including ethnicity, maternal depression, social support and other demographic variables thought to play a potential role in premature birth and poor pregnancy outcomes. In addition, the effectiveness of the multiple interventions provided to WIC mothers are being tested. Data are being entered into a database made available through a funding partnership with First 5 LA. First year data will be analyzed in February 2008 and preliminary results and policy implications will be discussed at the October APHA conference.