Interpregnancy Care Project-Mississippi (IPC-M)

In the United States, Low Birth Weight (LBW; less than 2500 grams) delivery is the leading
cause of infant mortality for African Americans. In addition, Very Low Birth Weight (VLBW;
less than 1500 grams) deliveries frequently result in severe chronic health problems and
lifelong disability in the surviving children. The racial disparity in infant mortality
between African Americans and Caucasians is widening throughout the United States. Since
Mississippi is the only state in the country with almost 50 percent of births to African
Americans, the impact on Mississippi is dramatic. Recent research has focused on fetal
origins of adult chronic diseases such as diabetes and hypertension. These findings confirm
that poor pregnancy outcomes such as VLBW infants are often trans-generational problems.
They are more common among women in poor health who lack continuous access to primary health
care.

The best clinical predictor of a woman's delivery of a VLBW infant is her history of a
previous VLBW delivery. The base line rate of very low birth weight for the general
population is 1.5 percent of live births. After the first VLBW delivery, African American
women have a 13.4 percent chance of another VLBW delivery. These figures are doubled in the
case of teen pregnancies and progressively rise with each additional VLBW delivery.
Mississippi has approximately 40,000 births per year; less than 2.5 percent (800) of these
pregnancies result in 50 percent of infant deaths.

In Mississippi, Medicaid coverage is available to many women during their pregnancies,
including a subset of women who do not financially qualify for Medicaid outside of
pregnancy. The majority of these women lose Medicaid eligibility approximately 60 days after
delivery; therefore, they do not have access to primary care resources. It appears that the
strategy that offers the greatest potential for increasing a high risk woman's chance of
having a full term healthy baby is preconceptual and inter-conceptual care.

The proposed project identifies and enrolls women in the Interpregnancy Care Project (IPC)
of Mississippi at discharge from the hospital following the delivery of a VLBW infant. The
IPC program provides 24 months of primary, continuous health care, basic dental care,
enhanced nurse case management, and community outreach via a resource mother or resource
worker. Primary health care addresses key areas epidemiologically linked to a VLBW delivery
including the following: 1) reproductive planning and short interpregnancy intervals; 2)
poorly-controlled chronic diseases; 3) reproductive tract infections; 4) nutritional
disorders and obesity; 5) depression and domestic violence; 6) substance abuse; and 7)
periodontal disease and cavities. Peer group meetings are integrated with IPC health care
visits. Resource mothers and resource workers focus on parenthood preparedness, safe
housing, job skills training, and education in the form of home visits and telephone
contact.

Inclusion Criteria:

- African American female

- Delivery of a VLBW (below 1500 grams) infant at University of Mississippi Medical
Center; can be liveborn or stillborn

- Transfer of an otherwise-qualifying VLBW infant to University of Mississippi Medical
Center within two months of birth

- Indigent or Medicaid-eligible during pregnancy

- Maternal residence in Hinds county or in one of the 18 delta counties in
Mississippi's Federal Health Districts I, III, or V

Exclusion Criteria:

- Non-English speaking women

- Pregnant women are excluded because the program is designed to study the benefits of
providing primary health care services during the interpregnancy period

- Women who are incarcerated or who are institutionally committed will be excluded
because they will not be available to participate in the intervention package.