South Carolina Partners for Preterm Birth Prevention: a regional perinatal initiative for the reduction of premature birth in a Medicaid population

Newman, Roger B.; Sullivan, Scott; Menard, M. Kathryn; Rittenberg, Charles; Rowland, Amelia; Korte, Jeffrey E.; Kirby, Heather

doi:10.1016/j.ajog.2008.07.047

Cited by 23 publications

(18 citation statements)

References 9 publications

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“…Receiving social services had no association with preterm birth. Newman et al 48 examined the impact that the South Carolina Partners for Preterm Birth Prevention, a public=private partnership for the reduction of premature birth in a Medicaid population, has on preterm birth and reported significant reduction in the rate of preterm births at <28 weeks. There was, however, no reduction in the overall frequency of preterm birth or low birth weight.…”

Section: Medicaid Birth Outcomes Under Enhanced Prenatal Care Servicesmentioning

confidence: 99%

Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Anum

Retchin

Strauss

2010

Journal of Women's Health

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Objectives: To determine if (1) birth outcomes among women on Medicaid differ significantly from outcomes of those with private insurance, after controlling for known risk factors, and (2) enhanced prenatal care influences care use and birth outcomes. Methods: This is a review of studies published between 1989 and 2009 that examined birth outcomes (1) between women on Medicaid and those with private insurance and (2) among Medicaid enrollees who received comprehensive prenatal care. Results: When corrected for risk variables, birth outcomes are not different between private insurance and Medicaid patients. The impact of comprehensive prenatal care programs on birth outcomes varies across states and regions. Conclusions: There is a need for critical evaluation of comprehensive programs in a regional and state context to determine opportunities for improvement.

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Section: Medicaid Birth Outcomes Under Enhanced Prenatal Care Servicesmentioning

confidence: 99%

Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Anum

Retchin

Strauss

2010

Journal of Women's Health

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“…Lower rates of PTB have been reported in observational studies of provider-initiated contact, 110 family nurse partnerships, and special programs for women with previous PTB. 111 Because the clinical presentation of preterm parturition is more subtle than parturition at term, early signs and symptoms such as pelvic pressure and change in vaginal discharge may be easily dismissed unless patients and caregivers communicate easily.…”

Section: Interventions Suggested To Reduce the Risk Of Recurrent Pretmentioning

confidence: 99%

Care for Women with Prior Preterm Birth

Iams

2010

Preterm Birth

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Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately. Keywordscerclage; prevention; progesterone; recurrent; preterm birth; risk estimation Efforts to reduce the incidence of preterm birth cannot yet be called successful but have produced sufficient information to justify management suggestions for clinicians, not only for strategies that do not work but also for those that do. The quality and number of clinical trials of interventions intended to reduce the incidence and/or morbidity of preterm birth has risen substantially in recent years, yielding data that can improve care for women at risk.An important advance has been the revision of the traditional model of preterm birth in which painful contractions or preterm membrane rupture were understood as the most common initial steps preceding cervical change. This concept has been challenged by observations from several clinical studies:• Drugs that arrest or inhibit uterine contractions can delay delivery but do not reliably reduce or prevent preterm birth. [1][2][3][4][5] • Assessment of contraction frequency is not a useful test to predict preterm birth, 6 and its use to detect and arrest initial or recurrent episodes of preterm labor does not affect the rate of preterm birth. [7][8][9] • Antibiotics that eradicate microorganisms associated with preterm birth also do not reliably reduce, and may sometimes increase, the incidence of preterm birth, especially in women with intact membranes. [10][11][12][13][14][15][16][17] • Progestational agents such as 17α-hydroxy-progesterone caproate reduce recurrent preterm birth in some women with a prior preterm birth, 18,19 especially those with early preterm birth 20 and short cervix, 21 but have no effect on preterm birth in multiple gestations. 22,23 NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2013 May 09. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript• Cervical cerclage can reduce recurrent preterm birth in women with a prior preterm birth and short cervix 24,25 but increases the risk of preterm birth in women with multiple gestation who also have a short cervix. 24 These findings suggest the following 4 substantive changes in the "contractions change the cervi...

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“…Several evaluation studies of regional or statewide prenatal case management programs have demonstrated reduction of low birthweight or preterm births among Medicaid recipients after program implementation. [6][7][8][9][10][11] Although the available literature reports a wide range of effect sizes, at least one recent randomized controlled trial of prenatal case management in New York demonstrated a >50% reduction in the adjusted odds of low birthweight. 12 The current study objective was to develop and validate a risk-scoring tool theoretically grounded in a social determinants model to quantify pregnancy risk within a Medicaid population.…”

Section: Introductionmentioning

confidence: 99%

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Goyal

Hall

Greenberg

et al. 2015

Journal of Women's Health

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Background: Despite prior efforts to develop pregnancy risk prediction models, there remains a lack of evidence to guide implementation in clinical practice. The current aim was to develop and validate a risk tool grounded in social determinants theory for use among at-risk Medicaid patients. Methods: This was a retrospective cohort study of 409 women across 17 Cincinnati health centers between September 2013 and April 2014. The primary outcomes included preterm birth, low birth weight, intrauterine fetal demise, and neonatal death. After random allocation into derivation and validation samples, a multivariable model was developed, and a risk scoring system was assessed and validated using area under the receiver operating characteristic curve (AUROC) values. Results: The derived multivariable model (n = 263) included: prior preterm birth, interpregnancy interval, late prenatal care, comorbid conditions, history of childhood abuse, substance use, tobacco use, body mass index, race, twin gestation, and short cervical length. Using a weighted risk score, each additional point was associated with an odds ratio of 1.57 for adverse outcomes, p < 0.001, AUROC = 0.79. In the validation sample (n = 146), each additional point conferred an odds ratio of 1.20, p = 0.03, AUROC = 0.63. Using a cutoff of 20% probability for the outcome, sensitivity was 29%, with specificity 82%. Positive and negative predictive values were 22% and 85%, respectively. Conclusions: Risk scoring based on social determinants can discriminate pregnancy risk within a Medicaid population; however, performance is modest and consistent with prior prediction models. Future research is needed to evaluate whether implementation of risk scoring in Medicaid prenatal care programs improves clinical outcomes.

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South Carolina Partners for Preterm Birth Prevention: a regional perinatal initiative for the reduction of premature birth in a Medicaid population

Cited by 23 publications

References 9 publications

Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Care for Women with Prior Preterm Birth

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

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