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Interpregnancy Primary Care and Social Support for African-American Women at Risk for Recurrent Very-low-birthweight Delivery: A Pilot Evaluation

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Abstract

Objectives Very-low-birthweight (VLBW) delivery accounts for the majority of neonatal mortality and the black–white disparity in infant mortality. The risk of recurrent VLBW is highest for African-Americans of lower socioeconomic status. This study explores whether the provision of primary health care and social support following a VLBW delivery improves subsequent child spacing and pregnancy outcomes for low-income, African-American women. Methods This pilot study of mixed prospective-retrospective cohort design enrolled African-American women who qualified for indigent care and delivered a VLBW infant at a public hospital in Atlanta from November 2003 through March 2004 into the intervention cohort (n 1 = 29). The intervention consisted of coordinated primary health care and social support for 24 months following the VLBW delivery. A retrospective cohort was assembled from consecutive women meeting the same eligibility criteria who delivered a VLBW infant during July 2001 through June 2002 (n 2 = 58). The number of pregnancies conceived within 18 months of the index VLBW delivery and the number of adverse pregnancy outcomes for each cohort was compared with Poisson regression. Results Women in the control cohort had, on average, 2.6 (95% CI: 1.1–5.8) times as many pregnancies within 18 months of the index VLBW delivery and 3.5 (95% CI: 1.0–11.7) times as many adverse pregnancy outcomes as women in the intervention cohort. Conclusions This small, pilot study suggests that primary health care and social support for low-income, African-American women following a VLBW delivery may enhance achievement of a subsequent 18-month interpregnancy interval and reduce adverse pregnancy outcomes.

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Acknowledgements

We gratefully acknowledge Ms. Michelle McIntosh and Ms. Patricia Ward who served as the nurse case manager and Resource Mother for this study. Funding and support for the conduct of this research study was provided by Vasser-Woolley Foundation, Grady Memorial Hospital, Healthcare Georgia Foundation, Centers for Disease Control and Prevention, Rockdale Foundation, Smith Family Foundation, March of Dimes, and the General Clinical Research Center at Emory University funded by the National Center for Research Resources (NCRR M01-RR00039).

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Authors and Affiliations

  1. Department of Family & Preventive Medicine, Emory University School of Medicine, 735 Gatewood Road NE, Atlanta, GA, 30322, USA

    Anne Lang Dunlop

  2. Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA, USA

    Cynthia Dubin & B. Denise Raynor

  3. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    George W. Bugg Jr. & Alfred W. Brann Jr.

  4. Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Brian Schmotzer

  5. World Health Organization Collaborating Center in Reproductive Health, Atlanta, GA, USA

    Alfred W. Brann Jr.

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  1. Anne Lang Dunlop
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Correspondence to Anne Lang Dunlop.

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Dunlop, A.L., Dubin, C., Raynor, B.D. et al. Interpregnancy Primary Care and Social Support for African-American Women at Risk for Recurrent Very-low-birthweight Delivery: A Pilot Evaluation. Matern Child Health J 12, 461–468 (2008). https://doi.org/10.1007/s10995-007-0279-z

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