Trends in pre-term deliveries among Medicaid women in Allegheny County

Objective: To determine possible health trends compared to prior years among female members of Gateway Health who all delivered prematurely from 2014-2015. Preterm birth (PTB) is a relevant public health concern due to the short and long term health effects of children born prematurely. PTB is the leading cause in the U.S. for infant mortality and newborn health complications and rates are much higher here than other developed countries. Identifying similar health trends within the Gateway member population can aid program development and targeted interventions to eventually decrease the amount of premature births in Allegheny County. Not only would this improve maternal and child health statistics in the area but also decrease associated hospital and insurance costs associated with premature birth. Methods: This paper analyzed 618 female members from Gateway Health via claims information submitted during prenatal visits and time of delivery. A total of 54,455 claims were utilized to identify leading indicators for spontaneous preterm birth amongst nulliparous (first time pregnant) women. Most important risk factors are noted under DX_1 and 2 claims and then sorted to find members who shared common risk factors indicating a possible health trend not already identified as high risk. Findings: A large amount of members were found to have indicated tobaccos smoking, drug dependency, mental disorders, periodontal disease, and hypertension during at least one prenatal visits. Also the average age of preterm delivery is from ages 18-31 which is younger than previously expected. Conclusions: Allegheny County has a higher than national average rate of prenatal care visits and yet still sees high rates of preterm births. Quality of prenatal care seems to be the main issue over quantity of visits seen. A cost effective solution on part of the Medicaid insurer would be to implement better detection strategies of women who may be at high risk for preterm birth. Low cost, non-invasive tests could be cervical measuring and cholesterol testing within the first trimester. Then utilization of progesterone 17 and other intervention therapies could help decrease the amount of PTB seen in Allegheny County amongst Medicaid women