Interpregnancy Care Project-Mississippi (IPC-M)
Condition: Premature Birth
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      The IPC program will enroll women who deliver Very Low Birth Weight babies (stillborn or
      liveborn) at University of Mississippi Medical Center and women who have Very Low Birth
      Weight babies that receive treatment in the Neonatal Intensive Care Unit at University of
      Mississippi Medical Center and provide each woman with 24 months of funded comprehensive,
      integrated, primary health care services (including family planning, social services, general
      medical services,and basic dental care), and enhanced case management. The services will be
      community-based (via UMC Clinics, community health centers, and outreach programs) and will
      be provided by a multidisciplinary team of physicians, nurses, social workers, case managers,
      and Resource Mothers/Resource Workers. At the end of project follow-up, we will evaluate the
      success of the program in terms of improvement of general health status of enrolled women,
      and subsequent reproductive health outcomes (i.e., achieving reproductive intentions,
      intendedness and spacing of subsequent pregnancies, birth weight distribution of subsequent
      pregnancies) and cost of delivery services compared to reproductive health outcomes in the
      project's control population.
    

Detailed description: 
      In the United States, Low Birth Weight (LBW; less than 2500 grams) delivery is the leading
      cause of infant mortality for African Americans. In addition, Very Low Birth Weight (VLBW;
      less than 1500 grams) deliveries frequently result in severe chronic health problems and
      lifelong disability in the surviving children. The racial disparity in infant mortality
      between African Americans and Caucasians is widening throughout the United States. Since
      Mississippi is the only state in the country with almost 50 percent of births to African
      Americans, the impact on Mississippi is dramatic. Recent research has focused on fetal
      origins of adult chronic diseases such as diabetes and hypertension. These findings confirm
      that poor pregnancy outcomes such as VLBW infants are often trans-generational problems. They
      are more common among women in poor health who lack continuous access to primary health care.

      The best clinical predictor of a woman's delivery of a VLBW infant is her history of a
      previous VLBW delivery. The base line rate of very low birth weight for the general
      population is 1.5 percent of live births. After the first VLBW delivery, African American
      women have a 13.4 percent chance of another VLBW delivery. These figures are doubled in the
      case of teen pregnancies and progressively rise with each additional VLBW delivery.
      Mississippi has approximately 40,000 births per year; less than 2.5 percent (800) of these
      pregnancies result in 50 percent of infant deaths.

      In Mississippi, Medicaid coverage is available to many women during their pregnancies,
      including a subset of women who do not financially qualify for Medicaid outside of pregnancy.
      The majority of these women lose Medicaid eligibility approximately 60 days after delivery;
      therefore, they do not have access to primary care resources. It appears that the strategy
      that offers the greatest potential for increasing a high risk woman's chance of having a full
      term healthy baby is preconceptual and inter-conceptual care.

      The proposed project identifies and enrolls women in the Interpregnancy Care Project (IPC) of
      Mississippi at discharge from the hospital following the delivery of a VLBW infant. The IPC
      program provides 24 months of primary, continuous health care, basic dental care, enhanced
      nurse case management, and community outreach via a resource mother or resource worker.
      Primary health care addresses key areas epidemiologically linked to a VLBW delivery including
      the following: 1) reproductive planning and short interpregnancy intervals; 2)
      poorly-controlled chronic diseases; 3) reproductive tract infections; 4) nutritional
      disorders and obesity; 5) depression and domestic violence; 6) substance abuse; and 7)
      periodontal disease and cavities. Peer group meetings are integrated with IPC health care
      visits. Resource mothers and resource workers focus on parenthood preparedness, safe housing,
      job skills training, and education in the form of home visits and telephone contact.
    

Intervention name(s): Interpregnancy Care; Interpregnancy Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention package includes: 1) Creation of an individualized interpregnancy care plan based on assessments of risks for subsequent poor pregnancy outcomes; 2) Basic dental care and provision of primary health care services for 24 months; 3) Assistance in achieving a woman's desire for subsequent pregnancies and her need for optimum child spacing (ideally at least 18 months); 4) Provision of appropriate social services and community outreach in each woman's community.; The intervention package includes: 1) Creation of an individualized interpregnancy care plan based on assessments of risks for subsequent poor pregnancy outcomes; 2) Basic dental care and provision of primary health care services for 24 months; 3) Assistance in achieving a woman's desire for subsequent pregnancies and her need for optimum child spacing (ideally at least 18 months); 4) Provision of appropriate social services and community outreach in each woman's community.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Interpregnancy Care; Preconceptual Care; Premature Birth; Preterm Delivery