Grady Memorial Hospital Interpregnancy Care Program

Grady Memorial Hospital’s interpregnancy care program served black women in the Atlanta area who had recently delivered a very low birthweight infant. Participants received case management, care coordination, and medical care including reproductive care, oral health services, and chronic disease management, as well as treatment and referral for alcohol, tobacco, and substance abuse. A medical provider educated patients about the health benefits of spacing pregnancies, and helped them develop reproductive plans. Trained laypeople called Resource Mothers also visited patients’ homes to assist with psychosocial stressors, life skills, parenting, employment, and housing and relationship issues. Services were provided for 24 months or until a subsequent pregnancy (Biermann 2006, Dunlop 2008*).

Expected Beneficial Outcomes (Rated)

  • Increased access to care

  • Improved birth outcomes

Other Potential Beneficial Outcomes

  • Reduced rapid repeat pregnancies

  • Improved care for chronic conditions

Evidence of Effectiveness

Grady Memorial Hospital’s model of interpregnancy care is a suggested strategy to increase access to care and improve subsequent birth outcomes for women with previous adverse birth outcomes (March of Dimes-Pregnancy). Available evidence suggests that such care may reduce rates of stillbirth and low birthweight births (Dunlop 2008*, Kent County 2010), reduce the likelihood of closely spaced pregnancies, increase identification of chronic conditions, and improve acquisition of life skills (Dunlop 2008*). However, additional evidence is needed to confirm effects.

The Grady Memorial Hospital intervention originally cost $2,397 per participant (Dunlop 2008*). In Michigan’s Kent County Infant Health Initiative, partially modeled on Grady’s approach, potential treatment costs for infants with poor birth outcomes far outweighed program expenditures (Kent County 2010).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Many programs are modeled after or similar to Grady Memorial Hospital’s interpregnancy care program. Examples of these programs include the Louisiana Birth Outcomes Initiative’s Healthy Start New Orleans Project (CWF-Foubister 2013), the Kent County Infant Health Initiative in Michigan (Kent County 2010), Christiana Care Healthy Beginnings in Delaware (Kroelinger 2008), the Mississippi Interpregnancy Care Project, and the Internatal Care Program in Arizona (AMCHP-EPBP).

Preliminary results from an evaluation of the Healthy Start New Orleans Inter-Pregnancy Care project indicate that such programs must consider patients’ clinical and socio-economic needs when determining how to effectively deliver care (Venturanza 2014).

Implementation Resources

Biermann 2006 - Biermann J, Dunlop AL, Brady C, Dubin C, Brann Jr. A. Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Maternal and Child Health Journal. 2006;10(5 Suppl):S21-8.

Citations - Evidence

* Journal subscription may be required for access.

March of Dimes-Pregnancy - March of Dimes. Toward improving the outcome of pregnancy III.

Dunlop 2008* - Dunlop AL, Dubin C, Raynor BD, et al. Interpregnancy primary care and social support for African-American women at risk for recurrent very-low-birthweight delivery: A pilot evaluation. Maternal and Child Health Journal. 2008;12(4):461-8.

Kent County 2010 - Kent County Health Department. Kent County Infant Health Initiative: Interconception Care Program. Final Report 2010.

Citations - Implementation Examples

* Journal subscription may be required for access.

CWF-Foubister 2013 - Foubister V. Case study: Louisiana's poor rankings make improving birth outcomes a state imperative. Quality Matters. New York: The Commonwealth Fund (CWF); 2013.

Kent County 2010 - Kent County Health Department. Kent County Infant Health Initiative: Interconception Care Program. Final Report 2010.

Kroelinger 2008 - Kroelinger C, Ehrenthal D. Translating policy to practice and back again: Implementing a preconception program in Delaware. Women's Health Issues. 2008;18(6 Suppl 1):S74–80.

AMCHP-EPBP - Association of Maternal & Child Health Programs (AMCHP). Innovation Station: Emerging, promising and best practices (EPBP) on infant mortality & improving birth outcomes.

Venturanza 2014 - Venturanza J. Lessons learned in adapting and implementing the Grady model of inter-pregnancy care. Abstract submitted to The 142nd Annual Meeting of the Public Health Association; November 15-19, 2014; New Orleans, LA.

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