Background:
Few preconception interventions comprehensively address the high chronic disease burden of African American women using culturally appropriate community perspectives. African American women have 4X the risk of maternal mortality and their infants 2.5X the risk of other U.S. populations. These tragic statistics mirror the contributions of high rates of chronic disease such as diabetes, hypertension as well as clinical depression of young African American women. While excellent clinical practice guidelines exist for the management of these individual health problems, these problems often co-occur for young African American women. Social problems such as family violence and extreme poverty further complicate the opportunities for healthy pregnancy outcomes. The Healthy Start Initiative provides a model for long-term comprehensive case management addressing both the social and community factors impacting chronic disease prevention and its management during the preconception period.

Objectives:
1. Identify the preconception risk factors and epidemiology of diabetes, hypertension and depression for African American women
2.Describe 3 social and cultural factors impacting chronic disease prevention and management for African American women
3.Discuss the comprehensive case management model used by Healthy Start to reduce disparities by chronic disease prevention and management strategies


Methods:
The Healthy Start program is a comprehensive case management model with an interdisciplinary team approach using home visits and community partnerships. Women are eligible for care for a three year period for each pregnancy including the prenatal and postnatal period until the second birthday of the infant. Women are eligible for enrollment for subsequent pregnancies. The Pittsburgh Healthy Start project that has served more than 750 women annually for more than 15 years will be used as a case example. Project data indicates that chronic disease burden is high for Healthy Start participants. Health education, screening, referrals and case management for depression, diabetes and hypertension will be described.

Results:
Chronic disease burden disparities impacting maternal and infant mortality and morbidities are reduced with a comprehensive case management model

Conclusion and implications for practice:
Chronic disease is a major contributor to adverse pregnancy outcomes. A holistic community-based approach must be used to effectively reach populations with co-morbidities as well as extreme poverty.