title: Interpregnancy primary care and social support for African-American women at risk for recurrent very-low-birthweight delivery: a pilot evaluation.
abstract: OBJECTIVE
  Very-low-birthweight (VLBW) delivery accounts for the majority of neonatal mortality and the black-white disparity in infant mortality. The risk of recurrent VLBW is highest for African-Americans of lower socioeconomic status. This study explores whether the provision of primary health care and social support following a VLBW delivery improves subsequent child spacing and pregnancy outcomes for low-income, African-American women.
  
  
  METHODS
  This pilot study of mixed prospective-retrospective cohort design enrolled African-American women who qualified for indigent care and delivered a VLBW infant at a public hospital in Atlanta from November 2003 through March 2004 into the intervention cohort (n (1) = 29). The intervention consisted of coordinated primary health care and social support for 24 months following the VLBW delivery. A retrospective cohort was assembled from consecutive women meeting the same eligibility criteria who delivered a VLBW infant during July 2001 through June 2002 (n (2) = 58). The number of pregnancies conceived within 18 months of the index VLBW delivery and the number of adverse pregnancy outcomes for each cohort was compared with Poisson regression.
  
  
  RESULTS
  Women in the control cohort had, on average, 2.6 (95% CI: 1.1-5.8) times as many pregnancies within 18 months of the index VLBW delivery and 3.5 (95% CI: 1.0-11.7) times as many adverse pregnancy outcomes as women in the intervention cohort.
  
  
  CONCLUSIONS
  This small, pilot study suggests that primary health care and social support for low-income, African-American women following a VLBW delivery may enhance achievement of a subsequent 18-month interpregnancy interval and reduce adverse pregnancy outcomes.
authors: Department of Family & Preventive Medicine, Emory University School of Medicine, 735 Gatewood Road NE, Atlanta, GA, 30322, USA. amlang@emory.edu
authors: Anne Lang
authors: AL
authors: Dunlop
authors: Cynthia
authors: C
authors: Dubin
authors: B Denise
authors: BD
authors: Raynor
authors: George W
authors: GW
authors: Bugg
authors: Brian
authors: B
authors: Schmotzer
authors: Alfred W
authors: AW
authors: Brann
mesh_terms: D001741:Black or African American; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D010865:Pilot Projects; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011320:Primary Health Care / Q000379:methods*; D014932:Women's Health Services
references: JAMA. 2006 Apr 19;295(15):1809-23
references: 16622143
references: Matern Child Health J. 2006 Sep;10(5 Suppl):S21-8
references: 16927159
references: N Engl J Med. 2000 Feb 24;342(8):534-40
references: 10684911
references: JAMA. 2000 Mar 22-29;283(12):1591-6
references: 10735396
references: Am J Perinatol. 2000;17(3):137-46
references: 11012138
references: Obstet Gynecol. 2000 Nov;96(5 Pt 1):741-8
references: 11042311
references: Am J Obstet Gynecol. 2000 Dec;183(6):1520-4
references: 11120521
references: Am J Public Health. 2001 Jan;91(1):105-11
references: 11189800
references: BJOG. 2001 Jan;108(1):61-6
references: 11213006
references: Paediatr Perinat Epidemiol. 2001 Jul;15 Suppl 2:17-29
references: 11520397
references: N Engl J Med. 2002 Jan 24;346(4):282-4
references: 11807155
references: Ann Periodontol. 2001 Dec;6(1):164-74
references: 11887460
references: Ann Periodontol. 2001 Dec;6(1):175-82
references: 11887461
references: Eur J Obstet Gynecol Reprod Biol. 2002 May 10;102(2):111-9
references: 11950476
references: S Afr Med J. 2002 Mar;92(3):231-4
references: 12040953
references: Obstet Gynecol. 2002 Aug;100(2):297-304
references: 12151153
references: J Matern Fetal Neonatal Med. 2002 Apr;11(4):245-8
references: 12375678
references: Am J Epidemiol. 2002 Nov 1;156(9):797-802
references: 12396996
references: Acta Obstet Gynecol Scand. 2002 Nov;81(11):1006-10
references: 12421167
references: Lancet. 2002 Nov 9;360(9344):1489-97
references: 12433531
references: Pediatrics. 2003 Jan;111(1):e61-6
references: 12509596
references: Lancet. 2003 Mar 22;361(9362):983-8
references: 12660054
references: N Engl J Med. 2003 Jun 12;348(24):2379-85
references: 12802023
references: Semin Perinatol. 2003 Jun;27(3):231-8
references: 12889590
references: Obstet Gynecol. 2003 Nov;102(5 Pt 1):1115-6
references: 14672496
references: N Engl J Med. 2004 Feb 19;350(8):777-85
references: 14973215
references: Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):3-15
references: 15294360
references: Am J Obstet Gynecol. 1985 Aug 15;152(8):1016-20
references: 4025447
references: Am J Prev Med. 1992 Sep-Oct;8(5):271-7
references: 1419125
references: Am J Obstet Gynecol. 1994 Aug;171(2):345-7; discussion 348-9
references: 8059811
references: N Engl J Med. 1995 Dec 28;333(26):1732-6
references: 7491136
references: Fertil Steril. 1996 Jun;65(6):1093-9
references: 8641479
references: N Engl J Med. 1998 Jan 15;338(3):147-52
references: 9428815
references: J Nurse Midwifery. 1998 Jan-Feb;43(1):46-54
references: 9489291
references: Am J Public Health. 1998 Feb;88(2):233-8
references: 9491013
references: Am J Public Health. 1998 Aug;88(8):1182-5
references: 9702144
references: Br J Obstet Gynaecol. 1999 Jul;106(7):652-7
references: 10428520
references: Arch Pediatr Adolesc Med. 2005 Jan;159(1):89-90
references: 15630064
references: Med Clin North Am. 2005 Sep;89(5):935-43, 941
references: 16129105
references: Am J Obstet Gynecol. 2005 Dec;193(6):1923-35
references: 16325593
references: Am J Obstet Gynecol. 2006 Mar;194(3):617-23
references: 16522388
references: MMWR Recomm Rep. 2006 Apr 21;55(RR-6):1-23
references: 16617292
references: Obstet Gynecol Surv. 1999 Dec;54(12):754-65
references: 10596396