Preterm births occur in 10% of US births, cause 36% of infant mortality, and cost $26 billion each year. Repeat preterm births represent approximately 20% of total prematurity. Preventive care that effectively addresses modifiable risks (e.g. tobacco use, weight status, interpregnancy interval) among women with a prior preterm birth could plausibly reduce overall preterm birth rates by 10% or more. However, our preliminary work found that 39% of Medicaid-insured women with a prior preterm birth received no preventive care in the year after pregnancy. Leveraging existing contact between pediatric health systems and new mothers, this research proposes a pediatric-based nurse intervention as a novel strategy to reduce prematurity. We hypothesize that nurse care coordination will increase receipt of preventive care. In addition, we propose embedding motivational interviewing within the care coordination model to address modifiable health risks. We hypothesize that this care coordination plus motivational interviewing intervention will increase receipt of preventive care and reduce modifiable behavioral risks, thus improving subsequent birth outcomes. The proposed intervention builds on existing care coordination models and on prior work demonstrating feasibility of maternal risk screening in pediatrics. This intervention innovates over existing interconception (IC) care models by: (1) locating our intervention in the pediatric health care system to capitalize on existing interactions, (2) focusing on strategies to address needs and risks identified through screening, and (3) implementing motivational interviewing within care coordination to better address modifiable risks. The candidate, Dr. Gregory, has conducted prior maternal-child health research focused on the IC period. Her long-term goal is to become an independent maternal-child health researcher developing clinical programs to improve birth outcomes. This five-year mentored research proposal will support her goal through course work and completion of mentored research. Candidate training will focus on three objectives: (1) motivational interviewing, an evidence-based behavior change strategy, (2) implementation science, and (3) pragmatic clinical trials. Research will address two specific aims.
(Aim 1) will adapt care coordination and motivational interviewing for women with a prior preterm birth. Using mixed methods, and starting with existing models of pediatric care coordination, adaptation will focus on the needs of women with a history of preterm birth and on integration of motivational interviewing.
(Aim 1 a: qualitative interviews;
Aim 1 b: iterative testing.) (Aim 2) will conduct a pilot pragmatic randomized trial of usual care vs care coordination plus motivational interviewing for women with a prior preterm birth. This trial will demonstrate intervention feasibility and estimate the effect size of the intervention on health care utilization. Findings will inform an R01 level trial testing this intervention as a strategy to reduce repeat preterm birth. This proposal aligns with NICHD research priorities of improving the health of women before, during, and after pregnancy and improving pregnancy outcomes.
Preterm births are common and costly, and medical and public health experts recommend preventive health care as one strategy to reduce preterm birth rates. Considering that many interconception women with a history of preterm birth do not receive preventive health care but have frequent contact with pediatric health systems in their roles as mothers, we propose a pediatric-based nurse intervention as a novel strategy to reduce preterm births. We hypothesize that care coordination activities will increase receipt of recommended preventive care and that motivational interviewing will support positive behavior change, leading to improvements in subsequent birth outcomes including decreased repeat preterm births.
