Population-based prenatal care management services for low income women: Identification of clinical and psychosocial risk factors for preterm birth and other adverse pregnancy outcomes in a pregnancy medical home model

Background: North Carolina (NC) launched an innovative, new Pregnancy Medical Home (PMH) initiative in April 2011, with an integrated pregnancy care management component provided by local public health departments. A diverse workgroup of stakeholders developed a pregnancy risk screening form, which is completed by the PMH provider at the initial prenatal visit of every Medicaid patient, to determine eligibility for care management. The model aims to improve the quality of maternity care and improve birth outcomes, with a focus on preventing preterm birth.

Methods: Initial pregnancy risk screening forms completed from 12/1/2011 to 12/31/2011 were analyzed for the presence of risk factors. Priority risk factors include: history of preterm birth or low birth weight, multiple gestation, fetal complications, chronic conditions, unsafe living environment, substance use, tobacco use, late entry to prenatal care or missing appointments, hospital utilization, and provider referral.

Results: 3,165 pregnant patients were screened for risk factors. 2,218 (70.1%) had one or more priority risk factors. The most common risk factors were late entry to prenatal care (>14 weeks), (22.7%), current smoker (20.1%), chronic condition (18.9%), and provider referral (16.1%).

Conclusions: At 70.1%, the pregnant Medicaid population with one or more priority risk factors exceeded original planning estimates of 50%. The most common risk factors are both systemic and individual. Barriers to early entry to prenatal care may be more reflective of system challenges for low-income women, whereas smoking is a patient-level concern. Interventions for various risk factors must consider both the patient and the broader care system.