Exploratory Analysis of the Pregnancy Risk Assessment Monitoring System to Identify Modifiable Factors Related
to Adverse Pregnancy and Birth Outcomes

Preterm births (births before 37 weeks gestation) and the associated complications including infant mortality (death before first year of life) have a significant impact on physical and mental health of mothers as well the health of the community. The rates of adverse birth outcomes within minority populations are especially troubling perpetuating a significant health disparity. Preconception health and interconception health are crucial to maintaining a woman's health as well as providing the environment for optimal birth outcomes. Understanding the association between particular risk factors and a woman's health in the preconception or interconception time is a strategy to reduce racial disparities in birth outcomes such that a mother's health and a child's health are inextricably linked in the life course. We intend to address the gaps in the literature by examining specific social determinants of health barriers to adequate and timely prenatal care and impediments to achieving full-term healthy infants. Our project will specifically examine potentially modifiable factors such as early and timely prenatal care social support education substance use and insurance and their relationship to preterm birth and infant mortality. We will provide sophisticated analyses of the Wisconsin Pregnancy Resource Assessment Monitoring System (PRAMS) and birth certificate/vital records data. We will use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to guide our work. We will incorporate previously published results on association of the modifiable factors with infant mortality and gestational age. The question driving the study proposal is whether substance use (including smoking) lack of insurance and inadequacy of prenatal care has a negative association on the adverse pregnancy and birth outcomes of preterm birth and infant morality. Understanding inequity of preconception/interconception care and adverse birth outcomes especially for rural and poor women aligns with the MCHB goal to eliminate health barriers and disparities and Strategic Research Issue II: MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations. We will use our research findings to articulate the types of disparities in access to early and timely prenatal care with special attention to women and children in rural communities. Our project also aligns with the MCHB goal to promote an environment that supports maternal and child health through Strategic Research Issue IV: Promoting the healthy development of MCH populations. Clinicians public health agencies and social services organizations can use our findings to design interventions that promote the healthy development of MCH populations