Background:
The Michigan Department of Community Health (MDCH) began an initiative in 2005 to pilot Interconception Care projects (ICC) in Michigan communities with the largest racial disparity in infant mortality. The goal is to field test an intervention strategy utilized in Colorado for its feasibility in local health department programs to reduce poor pregnancy outcomes in African American women who have already experienced a preterm birth, a low birth weight birth, a fetal death or a neonatal death.
Michigan's black infant mortality rate (IMR) of 17.9 in 2005 compares to the white IMR of 5.5 the same year. Almost 94% of Michigan's black births and 98% of black infant deaths happen in 11 urban communities in Michigan's Lower Peninsula. The largest incidence of morbidity and mortality occurs among very low birth weight babies due largely to preterm birth.

Objectives:
The purpose of this study is to pilot an Interconception Care strategy utilizing components of the Denver Health, Interconception Health Promotion Initiative. The focus of this study is reducing subsequent poor pregnancy outcomes in African American women who have experienced a preterm birth, a low birth weight birth, a fetal death or neonatal death.
The research questions that guide the project are: 1) What factors best describe the African American women at-risk of a poor pregnancy outcome? 2) What interventions are predictive of a good pregnancy outcome? 3) What factors are the most important in assuring participation of the eligible clients in the project? 4) How effective is the project in implementing the intervention model? 5) What factors help assure the sustainability of the interventions over time?

Methods:
This descriptive study compares outcomes for matched groups of African American women with a history of a poor pregnancy outcome; one group of which receives an intensive home visiting intervention; one group that receives individualized education and referral; and another that receives no intervention. MDCH identified communities with large racial disparity in infant mortality in 2005. Recruitment of 25 to 125 African American women in nine communities, depending on population size, is underway to receive the ICP. Women are offered grief support for loss, screening and assessment of medical, dental, and psychosocial risk factors, family planning counseling, case management through home visiting, nutrition counseling, depression screening and referral, substance abuse screening and referral. Standard protocol modifications are based on community strengths and cultural characteristics. Service is delivered up to two years or the beginning of a subsequent pregnancy. A group of 500 women is being recruited in one large community to receive education and referral to existing programs.
Each project is collecting individual client data that will be provided to MDCH for analysis. Data will be matched with birth certificates to answer the research questions and to determine if the goal of improving birth outcomes for individual women and for the group collectively was obtained. A comparison group will be identified using the same eligibility criteria but who did not receive the intervention. Outcomes of subsequent pregnancies will be analyzed with birth certificates.
Projects are encouraged to realign available local and state resources to support and implement the interventions. Coordination between this project and Healthy Start, Family Planning, Maternal Infant Health Program, Nurse Family Partnership and WIC is a major part of the work with systems of care.

Results:
Program development is foundational to the success of this state-local partnership and has shown success over the last 18 months. Ten local health departments with elevated black infant mortality rates have agreed to participate in this study. Each community established an Infant Mortality Coalition to educate core community leaders and to advise the health department in their project design; community needs assessments were done to determine gaps in service; and focus groups were held to capture the “Voice of the Women”. Plans for recruitment, eligibility screening, assessment, education, referral, and direct intervention have been completed.
Findings of the Perinatal Periods of Risk assessment for the participating communities demonstrate a remarkable need for intervention prior to pregnancy to reduce the preterm and very low birth weight births.
Preliminary findings suggest that recruitment strategies are effective in identifying eligible clients. Of the 10 participating health departments, all but one has at least one client enrolled, and three have at least four clients enrolled in this second month of a two year study.

Conclusion and implications for practice:
Results of this study will inform current maternal child health programs in effective services for interconception care particularly with women at-risk of a poor pregnancy outcome. Modifications of the Medicaid prenatal support services program will be made to incorporate services for women between pregnancies.