Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia

Abstract

Background: Prevention of avoidable preterm birth in Aboriginal and Torres Strait Islander (Indigenous) families is a major public health priority in Australia. Evidence about effective, scalable strategies to improve maternal and infant outcomes is urgently needed. In 2013, a multiagency partnership between two Aboriginal Community Controlled Health Organisations and a tertiary maternity hospital co-designed a new service aimed at reducing preterm birth: 'Birthing in Our Community'. Methods: A prospective interventional cohort study compared outcomes for women with an Indigenous baby receiving care through a new service (n = 461) to women receiving standard care (n = 563), January 2013-December 2017. The primary outcome was preterm birth (b 37 weeks gestation). One to one propensity score matching was used to select equal sized standard care and new service cohorts with similar distribution of characteristics. Conditional logistic regression calculated the odds ratio with matched samples. Findings: Women receiving the new service were less likely to give birth to a preterm infant than women receiving standard care (6•9% compared to 11.6%). After controlling for confounders, the new service significantly reduced the odds of having a preterm birth (unmatched, n = 1024: OR = 0•57, 95% CI 0•37, 0•89; matched, n = 690: OR = 0•50, 95% CI 0•31, 0•83). Interpretation: The short-term results of this service redesign send a strong signal that the preterm birth gap can be reduced through targeted interventions that increase Indigenous governance of, and workforce in, maternity services and provide continuity of midwifery carer, an integrated approach to supportive family services and a community-based hub.

Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: ‘Its Important, but How These Discussions Are Held Is Critical’

“…Parents experiencing complex trauma may have had a childhood history of previously disclosing abuse and not being believed by family, other community members or service providers, which impacts on trust and a sense of connectedness, which in turn can impact on and compound experiences of grief and loss. Growing evidence supports continuity of carer perinatal care models to enable relationships to be developed, including comprehensive multidisciplinary models (Hickey et al, 2018) which have demonstrated significant improvements in birth outcomes (Kildea et al, 2019). Knowing when a trusting relationship has been established can be a challenge in the context of busy perinatal clinical settings.…”

Parental mental health before and during pregnancy and offspring birth outcomes: A 20-year preconception cohort of maternal and paternal exposure

“…The retained and participating samples were broadly representative of the baseline VAHCS and eligible VIHCS samples respectively on measured baseline characteristics, but may differ on unmeasured confounders. Similarly, we were unable to examine associations within specific population groups known to have higher rates of preterm births, such as Aboriginal and Torres Strait Islander peoples [ 63 , 64 ], and this remains an area for future research. The sample in this study was relatively small, reducing precision of our estimates; findings should be interpreted as preliminary, and need replication in larger or pooled samples with similarly strong longitudinal designs.…”

The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth

“…A significant reduction was observed in PTB rates in women resident in the Kimberley region and classified as low risk. This region is known to have one of the nation's highest rate of preterm birth and low birthweight [14] and 58% of births are to indigenous women in whom the PTB rate is typically 14% or more [15,16]. A strategic decision was made at the outset to specifically target this region.…”