Reducing Preterm Births in Underserved Pregnant Women

描述（由申请人提供）：早产造成75%的新生儿死亡率和一半的儿童长期神经损伤，以及所有与出生相关的短期和长期发病率的相当一部分。在美国，大约12.8%的婴儿（每年超过50万）早产。自20世纪80年代初以来，早产率增加了36%。低出生体重婴儿的比例在医疗服务不足和少数民族人口中更高即使考虑到诸如获取和保险覆盖等问题。早产占婴儿保健支出的30%，占儿童保健支出的10%。美国的社会成本估计为每年260亿美元。虽然大多数早产发生在没有任何已知的早产风险因素的妇女中，但有些妇女显然比其他妇女面临更大的风险。研究人员已经确定了一些可改变的生活方式风险因素和与早产相关的医疗条件，可以在怀孕期间解决。及时筛查和管理可改变的风险和循证护理可能会降低早产的风险。然而，在临床环境中提供有效的产前风险管理系统，以满足医疗服务不足的妇女的独特需求是复杂的。及时筛查和管理可改变的疾病可以减少早产，提高孕产妇和儿童的生活质量。然而，提供有效的产前风险管理系统，以满足医疗服务不足的人群的独特需求是复杂的。该提案的目标是测试基于诊所的计算机辅助干预系统的有效性，以减少高风险，服务不足的人群中的早产。该系统将：（1）评估孕妇在六个与早产风险增加有关的可改变领域的独特风险，包括戒烟、营养不良、家庭暴力、产妇抑郁和压力、泌尿和生殖道感染以及物质使用;（2）为她提供减少风险的定制建议;（3）为该妇女的医生或注册助产士提供咨询建议和行动计划工具，专门针对患者的需要;以及[（4）鼓励诊所转诊和后续跟进，以确保她成功地利用社区组织的服务来帮助解决家庭暴力和药物使用/滥用等复杂问题。]在这项拟议的计划中，我们将测试该系统的能力，以（1）减少出生率小于37周和出生体重小于2500克;（2）改变行为，可以减少风险，使用一个平衡的前瞻性随机对照多中心试验，452例患者在产前护理诊所访问期间开始在第一个三个月。这项建议将建立在一个成功的I期研究，我们评估了该系统的可接受性和可行性与患者和他们的医生和/或认证护士助产士。 公共卫生相关性：早产占婴儿所有卫生保健支出的30%，占儿童支出的10%。自20世纪80年代初以来，早产率上升了36%。及时筛查和管理可改变的条件可以减少早产，但提供有效的产前风险管理系统，以满足医疗服务不足人群的独特需求是复杂的。如果拟议的系统被证明在减少早产方面是有效的，它可以改善母婴生活质量，并减轻美国早产的经济负担。

DESCRIPTION (provided by applicant): Preterm births are responsible for 75% of neonatal mortality and one-half of long-term neurological impairments in children as well as a substantial portion of all birth-related short- and long-term morbidity. In the United States, about 12.8 percent of babies (more than 500,000 per year) are born prematurely. The rate of premature birth has increased by 36 percent since the early 1980s. Rates of low birth weight babies are higher in medically underserved and minority populations-even when issues such as access and insurance coverage are accounted for. Preterm births account for 30% of all health care spending on infants and 10% of spending for children. Societal costs in the US are estimated at $26 billion annually. Although most preterm births occur in women who do not have any of the few known risk factors for preterm birth some women are clearly at greater risk than others. Researchers have identified some modifiable lifestyle risk factors and medical conditions associated with preterm births that can be addressed during pregnancy. Timely screening and management of modifiable risks and evidence-based care can potentially reduce risks for preterm labor. Yet providing effective prenatal risk management systems in a clinical setting to meet the unique needs of medically underserved women is complex. Timely screening and management of modifiable conditions can reduce preterm births and improve maternal and child quality of life. However, providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. The goal of this proposal is to test the efficacy of a clinic-based, computer-assisted intervention system to reduce preterm births in high-risk, underserved populations. This system will: (1) assess a pregnant woman's unique risks in six modifiable areas associated with increased risks of preterm birth including smoking cessation, poor nutrition, domestic violence, maternal depression and stress, urinary and reproductive tract infections and substance use; (2) provide her with tailored advice on reducing her risks; (3) provide counseling suggestions and action planning tools for that woman's physician or certified nurse midwife specifically tailored for the patient's needs; and [(4) encourage referrals from the clinic as well as follow-up to ensure that she is successful in utilizing services from community-based organizations to help with complex problems such as domestic violence and substance use/abuse-when they exist.] In this proposed program, we will test the ability of the system to (1) reduce rates of births less than 37 weeks and birth weights less than 2500 grams; and (2) change behaviors that can reduce risks using a balanced prospective randomized controlled multi-site trial with 452 patients during prenatal care clinic visits beginning during the 1st trimester. This proposal would build on a successful Phase I study where we assessed the acceptability and feasibility of this system with patients and their physician and/or certified nurse midwife. PUBLIC HEALTH RELEVANCE: Preterm births account for 30% of all health care spending on infants and 10% of spending for children. The preterm birth rate has risen 36% since the early 1980s. Timely screening and management of modifiable conditions can reduce preterm births, yet providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. If the proposed system proves to be effective in reducing preterm births it can improve maternal and child quality of life as well as reduce the economic burden of preterm births in the U.S.