Objective To determine which combination of risk factors from Community Care of North Carolina’s (CCNC) Pregnancy Medical Home (PMH) risk screening form was most predictive of preterm birth (PTB) by parity and race/ethnicity. Methods This retrospective cohort included pregnant Medicaid patients screened by the PMH program before 24 weeks gestation who delivered a live birth in North Carolina between September 2011-September 2012 (N=15,428). Data came from CCNC’s Case Management Information System, Medicaid claims, and birth certificates. Logistic regression with backward stepwise elimination was used to arrive at the final models. To internally validate the predictive model, we used bootstrapping techniques. Results The prevalence of PTB was 11%. Multifetal gestation, a previous PTB, cervical insufficiency, diabetes, renal disease, and hypertension were the strongest risk factors with odds ratios ranging from 2.34 to 10.78. Non-Hispanic black race, underweight, smoking during pregnancy, asthma, other chronic conditions, nulliparity, and a history of a low birth weight infant or fetal death/second trimester loss were additional predictors in the final predictive model. About half of the risk factors prioritized by the PMH program remained in our final model (ROC=0.66). The odds of PTB associated with food insecurity and obesity differed by parity. The influence of unsafe or unstable housing and short interpregnancy interval on PTB differed by race/ethnicity. Conclusions Evaluation of the PMH risk screen provides insight to ensure women at highest risk are prioritized for care management. Using multiple data sources, salient risk factors for PTB were identified, allowing for better-targeted approaches for PTB prevention.

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preterm vs. term birth in the index twin pregnancy. The analysis was further stratified by gestational age at birth, indication for PTB and chorionicity in the index twin pregnancy. Unadjusted odds ratios and confidence intervals were calculated for each of the objectives. RESULTS: A total of 378 women met the study inclusion criteria, of whom 252 (66.7%) had PTB in the index twin pregnancy. The overall rate of PTB in the subsequent singleton pregnancy was 11.6% (44/378) and was significantly higher for women with prior twin PTB compared with women with prior term twin birth (17.5% vs. 6.3%, p¼ 0.003, OR 3.12, 95%-CI 1.42-6.85). The risk of PTB in the subsequent singleton pregnancy was related to the degree of prematurity in the index twin delivery (Figure). The association between previous twin PTB and subsequent singleton PTB was significant only for cases of prior spontaneous twin PTB (OR 3.27, 95%-CI 1.47-7.27) but not for cases of prior indicated twin PTB (OR 2.52, 95%-CI 0.86-7.38). Chorionicity in the index twin delivery did not affect the relationship between prior twin PTB and risk of future singleton PTB. CONCLUSION: History of preterm twin birth is associated with higher odds of subsequent preterm singleton birth, and the risk is related to the severity of prematurity in the index twin PTB.

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