Reducing Preterm Births in Underserved Pregnant Women

描述（由申请人提供）：早产导致75%的新生儿死亡率和一半的儿童长期神经损伤，以及相当一部分与出生相关的短期和长期发病率。在美国，大约12.8%的婴儿（每年超过50万）是早产的。自20世纪80年代初以来，早产率上升了36%。在医疗服务不足和少数民族人群中，低出生体重婴儿的比例更高——即使考虑到医疗服务和保险覆盖等问题。早产占婴儿保健支出的30%，占儿童保健支出的10%。据估计，美国每年的社会成本为260亿美元。虽然大多数早产发生在没有任何已知早产风险因素的妇女身上，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，这些因素和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以潜在地降低早产风险。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条件可减少早产并改善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人群的独特需求是复杂的。这项提议的目的是测试一个基于临床的计算机辅助干预系统在高风险、服务不足人群中减少早产的有效性。该系统将：(1)评估孕妇在六个与早产风险增加相关的可修改领域的独特风险，包括戒烟、营养不良、家庭暴力、孕产妇抑郁和压力、泌尿和生殖道感染以及药物使用；(2)为其提供量身定制的降低风险建议；(3)为该妇女的医生或注册护士助产士提供专门针对患者需求的咨询建议和行动计划工具；并且[(4)鼓励从诊所转介以及后续跟进，以确保她成功地利用社区组织的服务来帮助解决复杂的问题，如家庭暴力和药物使用/滥用-当它们存在时。在这个拟议的计划中，我们将测试该系统的能力：(1)降低37周以下的出生率和出生体重低于2500克；(2)通过一项平衡前瞻性随机对照多地点试验，改变可降低风险的行为，该试验包括452名从妊娠早期开始的产前护理门诊就诊的患者。该建议将建立在成功的I期研究的基础上，在I期研究中，我们评估了该系统在患者及其医生和/或认证助产士中的可接受性和可行性。

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.