In 2011, North Carolina implemented the Pregnancy Medical Home (PMH) program, an initiative designed to improve outcomes for pregnant people on Medicaid by providing them with comprehensive care from a team of professionals.
In addition to medical providers, the team includes individuals who can help pregnant people address various social and economic factors that put them at greater risk of having a poor pregnancy outcome.
Researchers analyzed data from January 2016 to December 2017. The study included 3,565 pregnant people in North Carolina on Medicaid. Individuals were categorized as either high-risk or low-risk using a screening assessment tool, the Maternal-Infant Impact ability Score (MIIS).
Those classified as high-risk had at least three of the following risk factors: a prior preterm birth, high blood pressure, smoked, used recreational drugs or alcohol, had a mental health condition, experienced domestic violence, had housing instability, or suffered from food insecurity.
High-risk pregnant people were then assigned a care manager who provided a range of support during their pregnancy, including calling the pregnant person for a check-up, accompanying to appointments, and helping to address the social and economic factors.
Out of the study’s 3,565 pregnant people, the overall preterm birth rate was 18.3 percent. Researchers also looked at how effective the screening tool was for pregnant people who were in the highest risk category.
Results revealed that when the screening tool was used and assuming pregnant people received subsequent care management, the preterm birth rates for Black and White people decreased.
However, the preterm birth rate for Black people decreased significantly from 24.4 percent to 20.1 percent, while the rate decreased only slightly for White people from 15.6 percent to 15.5.
For Black people who received intensive care management during pregnancy, the preterm birth rate was 16.9 percent vs. 26.0 percent for Black people who did not receive intensive care management during pregnancy.
For White people who received intensive care management during pregnancy, the preterm birth rate was 12.3 percent vs. 17.8 percent for White people who did not receive intensive care management during pregnancy.
“Regardless of your risk factors, what this research shows is that if you have intensive care management while you’re pregnant someone who’s there for you throughout your pregnancy it helps lower your risk of delivering your baby prematurely,” says the study’s lead author Divya Mallampati, MD, MPH, a maternal-fetal medicine fellow at University of North Carolina at Chapel Hill.
Research also reveals that people who are at the highest risk benefit the most from having intensive care management during pregnancy. The next step is to analyze whether the PMH model helps to improve other health outcomes in pregnancy.