Using perinatal risk assessment to guide health disparities intervention

Background. Infant mortality is a major public health problem and African American women are at increased risk for poor birth outcomes. The present study describes an approach to screening and identifying high risk women.

Methods. Research staff administered anonymous surveys to African-American women attending their first prenatal visit (N=404) in an urban hospital-based obstetric clinic. Screening tools were developed to identify social and medical risk factors that impact pregnancy outcomes. Data from the survey were used to select patients from the general clinic population who could most benefit from intervention. Cut-off scores were determined through an iterative process of examining the prevalence of each risk domain and accounting for the risk it contributes both to inadequate prenatal care and to the fetus.

Results. The screening tool successfully identified women with high risk medical and social conditions (37%). Many women surveyed reported depressive symptoms (42%), and approximately 15% reported they were the victim of some type of domestic violence in the past year. Furthermore, almost 1/3 reported drinking alcohol in the previous 3 months and 13% had used drugs in that time; 25% had smoked cigarettes in the past week.

Discussion. The screener is a simple and efficient tool to inform decision-making in identifying women who would benefit from an evidence-based practice and provides insight into the distribution of risks in this pregnant African-American population.