Grady Memorial Hospital Interpregnancy Care Program

Evidence Rating  
Expert Opinion
Evidence rating: Expert Opinion

Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.

Health Factors  
Decision Makers

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 pregnancy1, 2.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased access to care

  • Improved birth outcomes

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced rapid repeat pregnancies

  • Improved care for chronic conditions

What does the research say about effectiveness? This strategy is rated expert opinion.

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 outcomes3. Available evidence suggests that such care may reduce rates of stillbirth and low birthweight births2, 4, reduce the likelihood of closely spaced pregnancies, increase identification of chronic conditions, and improve acquisition of life skills2. However, additional evidence is needed to confirm effects.

The Grady Memorial Hospital intervention originally cost $2,397 per participant2. 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 expenditures4.

How could this strategy impact health disparities? This strategy is rated 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 Project5, the Kent County Infant Health Initiative in Michigan4, Christiana Care Healthy Beginnings in Delaware6, the Mississippi Interpregnancy Care Project, and the Internatal Care Program in Arizona7.

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 care8.

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.


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1 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.

2 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.

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

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

5 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.

6 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.

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

8 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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