Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk

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Alarming racial and ethnic disparities in maternal mortality persist in the US. Black women are three to four times more likely to die a pregnancy-related death as compared with White women, and in some regions Latinas are also at increased risk. This disparity is rooted in the fact that Black and Latina women experience elevated maternal health risks throughout the pregnancy-postpartum continuum. Women of color are more likely to begin pregnancy with a chronic health condition such as hypertension or diabetes, experience a complication while pregnant, and to suffer a life-threatening morbidity during delivery. Less recognized is that heightened maternal health risks extend into the postpartum period. Black and Latina women are more likely to experience a postpartum complication, to seek care in the emergency department (ED) after delivery, and have an increased risk of postpartum hospital readmission relative to White women. Growing attention has focused on the postpartum period as an important window to address maternal mortality disparities as half of pregnancy-related deaths occur within one day to one year after delivery and the majority of maternal deaths and a sizable portion severe complications are preventable. We propose a mixed method study to better identify Black and Latina women most at risk for poor outcomes following delivery, the problems they experience, and to adapt an evidence-based intervention that aims to improve quality of postpartum care for high risk women. The aims of our research study, “Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk” are to: 1) Develop a risk a prediction model using sociodemographic, clinical, behavioral, and neighborhood factors to identify high-risk mothers using ED visits and postpartum readmissions as a marker of severe maternal morbidity. 2) Use qualitative methods to adapt and intensify an evidence-based behavioral educational intervention aimed at improving quality of care to reduce severe maternal morbidity as measured by postpartum ED use and hospital readmission, 3) Conduct a pilot RCT utilizing the cohort identified by the risk prediction model in Aim 1 to assess feasibility, acceptability, and target effect size and potential efficacy of the refined intervention to reduce ED visits and postpartum readmissions, and 4) Evaluate the pilot study results and procedures to inform the refinement of the intervention and to prepare for a larger implementation trial of this intervention.