Please select the eligibility criteria that correspond to the clinical trial below.
Title: Tennessee Connections for Better Birth Outcomes
Brief Summary: Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age was 27.6 years. Racial breakdown mirrored local demographics. Most women had a partner, a high school education, and Medicaid. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.


Options:
A: Inclusion Criteria:

* Pregnant women \& participants who agree to participate in the study

Exclusion Criteria:

* Pregnant women \& participants who disagree to participate in the study
B: Inclusion Criteria:

* 18 years of age or older
* Between 6-30 weeks pregnant
* Enrolled as a patient at the local health department (LHD) or Brody School of Medicine Regional Perinatal Center (BSOM-RPC)
* Self-identified as African American, Caucasian, or Hispanic
* Able to read at a 4th grade level;
* Have a or score \>4 on the Edinburgh Postnatal Depression Scale (EPDS)
* Are willing to complete the informed consent form
* Enrolled in Medicaid or are low-income based on Women's Infant and Children (WIC) eligibility criteria.

Exclusion Criteria:

* Have had a spontaneous abortion before 20 weeks of pregnancy
* Diagnosed with schizophrenia or bipolar disorder with or without psychosis, or are currently receiving treatment for depression; or have an organic mental disorder
* Diagnosed with a high-risk pregnancy that requires bed rest or hospitalization-- Demonstrated an active suicidal plan
* Had a concurrent medical condition, such as hypothyroidism, that would explain depression.
C: Inclusion Criteria:

* Pregnant
* Able to attend group treatment sessions conducted in English or Spanish

Exclusion Criteria:

* Positive HIV infection
* Severe medical problem requiring individualized assessment and tracking as high-risk pregnancy
D: Inclusion Criteria:

* Documented history of previous preterm delivery. Defined as delivery from 20 weeks to 36 weeks 6 days gestation.
* Proven pregnancy
* Reside in Davidson County, Tennessee (TN) or surrounding county in 90 mile driving radius.
* Less than 24 weeks gestation at enrollment
* Will receive prenatal care at a Vnderbilt University Medical Center (VUMC) clinic
* Willing to accept nurse home visits and be randomly assigned to conventional care or care with home visits
* Speaks and understands English
* Between the ages of 18 and 40 years.

Exclusion Criteria:

* Known fetal anomaly that can not be managed conservatively or fetal demise
* Maternal medical or obstetrical complications including:

  * Current or scheduled cervical cerclage
  * PROM in current pregnancy prior to enrollment
* Participation in an antenatal study in which the clinical status or intervention may influence gestational age at delivery
* Profound mental dysfunction or under guardianship

Answer: D