Background:
Very-low-birthweight (VLBW) delivery accounts for the majority of neonatal mortality and the black-white disparity in infant mortality. The risk of recurrent VLBW is highest for African-Americans of lower socioeconomic status. This study explores whether the provision of primary health care and social support following a VLBW delivery improves subsequent reproductive health outcomes for low-income, African-American women.

Objectives:
1. Recognize the contribution of very low birth weight (VLBW) delivery to infant mortality in the United States;
2. Identify medical, obstetrical, psychosocial, and behavioral risk factors for a VLBW delivery;
3. Describe elements of an interpregnancy care intervention associated with achievement of an 18-month interpregnancy interval and a reduction in adverse pregnancy outcomes for this pilot study.

Methods:
This pilot study of mixed prospective-retrospective cohort design enrolled African-American women who qualified for indigent care and delivered a VLBW infant at a public hospital in Atlanta from November 2003 through March 2004 into the intervention cohort (n1 = 29). The intervention consisted of coordinated primary health care and social support for 24 months following the VLBW delivery. A retrospective cohort was assembled from consecutive women meeting the same eligibility criteria who delivered a VLBW infant during July 2001 through June 2002 (n2 = 58). The number of pregnancies conceived within 18 months of the index VLBW delivery and the number of adverse pregnancy outcomes for each cohort was compared with Poisson regression.

Results:
Women in the control cohort had, on average, 2.57 (95% CI: 1.14 – 5.78) times as many pregnancies within 18 months of the index VLBW delivery and 3.51 (95% CI: 1.04 – 11.73) times as many adverse pregnancy outcomes as women in the intervention cohort.

Conclusion and implications for practice:
This small, pilot study suggests that primary health care and social support for low-income, African-American women following a VLBW delivery may enhance achievement of a subsequent 18-month interpregnancy interval and reduce adverse pregnancy outcomes.