Partnering for Prematurity Prevention: A Patient-Centered Approach to Reducing Disparities in Preterm Birth

Preterm birth, complicating 12% of pregnancies, is the leading cause of neonatal morbidity and mortality. One hallmark of preterm birth prevention is the timely and consistent utilization of 17-alpha-hydroxyprogesterone caproate (17P), a weekly intramuscular injection demonstrated to reduce the risk of recurrent preterm birth. Unfortunately, despite this advance, women from minority racial/ethnic and socioeconomic groups remain at the highest risk of preterm birth. Our group recently identified that in our Northwestern community, non-Hispanic black women are at a significantly increased risk of non-adherence to the recommended 17P regimen.1 This disparity was particularly pronounced in women who are publicly insured. These data suggest that improving 17P adherence may represent one modality to reduce racial/ethnic disparities in preterm birth and improve outcomes for vulnerable women and children. Thus, we propose a multilevel patient-centered approach to improving 17P adherence. Phase One will seek patient input on barriers to 17P initiation and utilization among low-income, minority women at risk of recurrent preterm birth. Phase Two will incorporate identified barriers and implement a Prematurity Navigator Program in which all women at risk of recurrent preterm birth receive individualized navigation services from initiation of prenatal care through the postpartum period. Phase Three is a 360-degree programmatic evaluation for sustainability planning.