Intervention Screening Patterns and Birth Outcomes: Findings from the IMPLICIT Network in Allegheny County, PA

IMPLICIT (Interventions to Minimize Preterm Birth and Low Birth Weight Infants through Continuous Improvement Techniques), a network of family medicine residency training sites in the northeastern United States, focuses on continuous quality improvement efforts for maternal care. Three sites are located in Allegheny County, PA. Retrospective program data for women with singleton live births from 2007-2010 (N=1323) in Allegheny County, PA were analyzed. Two primary research questions asked were: (1) what is the association between screening for prematurity risk factors such as depression, smoking, bacterial vaginosis and asymptomatic bacteriuria and outcomes of the interventions for addressing these risk factors; and were there differences by race, age and education level? (2) were there changes in depression and smoking behaviors among the women during the course of their pregnancy and were there differences by race, age, and education? Data was collected at baseline - 15 weeks gestation, at 30 weeks gestation, and at postpartum (after child birth). Baseline and follow-up data were analyzed as descriptive statistics for demographic variables. Further analyses would be performed on changes in smoking, depression and other factors for prematurity. Preliminary findings show that most women who smoked are white, have high school education or less and are between 20 and 34 years of age. The findings are also similar for women who were diagnosed with depression. At 15 weeks, of the women who were screened and diagnosed as smokers 81% (433/532) were treated. The results also indicate a slight decrease in smoking from previous visit (between Week 15 and 30) by women smokers at the onset of their pregnancy who benefited from a smoking intervention program (27.8% quit smoking). At 15 weeks, of the women who were screened and diagnosed with depression 94% (187/199) were treated. At 30 weeks, only 9.6 % (19/198) received continued or follow-up treatment. At 15 weeks, out of the women that were screened for asymptomatic bacteriuria, 13% (153/1180) were positively diagnosed, 68% (147/217) were treated, and 76% (103/135) had negative cure results during next visit. Of the 50 pregnant women screened for bacterial vaginosis, 30% (15/50) who tested positive were treated and 47% (7/15) tested negative during the next visit. Majority of women screened, diagnosed and treated are black. These findings suggest although screening and diagnosis for risk factors during pregnancy can be easily implemented, many challenges were associated with inventions for smoking cessation, depression and other risk factors for premature birth.