A Strong Start for At-Risk Moms and Babies

By Christina Crowe and Matt Windsor

UAB is participating in the Strong Start for Mothers and Newborns initiative to find the best ways to eliminate long-term health problems for at-risk women and their children.From the moment they are born, most babies in the United States have their health care looked after in some fashion. The health of the mothers who carry them for nine months, however, is often overlooked—especially by the mothers themselves, says Mario Drummonds, executive director and CEO of the Northern Manhattan Perinatal Partnership (NMPP).

Drummonds recently visited UAB to deliver the 2013 Ann Dial McMillan Endowed Lecture in Family and Child Health in the UAB School of Public Health. He shared lessons from his group's successful efforts to improve the health of mothers and infants in central Harlem. (Learn more about the NMPP's success and Drummond's call to action at UAB in this related article.) "Mom's health," Drummonds says, is "always secondary. Part of our job is to make her health, as well as the overall health of the household, primary."

Maternal and child health is a major challenge in Alabama. "High rates of premature birth, obesity, diabetes, hypertension, and substance abuse plague our state," says Joseph Biggio, M.D., professor of medicine and director of the UAB Division of Maternal and Fetal Medicine But thanks to a major grant from the federal Centers for Medicare and Medicaid Services, UAB can now offer intensive help to mothers and babies with the greatest needs.

Enhancing Care

The goal of the Strong Start for Mothers and Newborns initiative is to identify the best ways to prevent significant, long-term health problems for high-risk pregnant women and newborns enrolled in Medicaid or the Children's Health Insurance Program. In addition to UAB, 26 organizations across the United States are taking part in the Strong Start initiative.

Alabama's Medicaid Maternity Care Program currently does not provide non-medical social services to promote healthy living and reduce poor pregnancy outcomes. UAB's four-year, $730,000 Strong Start grant will address that gap by enhancing services offered at UAB clinics in and around Jefferson County. It includes enhanced screening for substance abuse, including illicit drugs as well as tobacco; social support for women with domestic issues such as income or domestic violence; screening for depression; and nutrition and dietary counseling.

As they enroll women in Strong Start, UAB's medical team has at times been taken aback by the stories they hear. "We always knew that our patients had many challenges, but I don't think we realized the magnitude of some of those challenges," Biggio says. "We feel like they are opening up a lot more now because someone is actually sitting down and taking the time to ask them about their lives to this level of detail. But they're also opening up because they know it's not just talk—that services are available for them."

A Healthy Home for Mom

The model adopted by UAB is known as the "maternity home," Biggio says. "If you think about most care that any patient gets, whether or not they're pregnant, it's fragmented. Your doctor may tell you to lose weight or quit smoking, but it's up to you to set that up."

Patients who choose to enroll in Strong Start—the goal is to enroll between 1,200 and 1,500 over the course of two years, Biggio says—will first get a comprehensive assessment of their needs. Next, "we educate the patient on why things like quitting smoking, eating healthy, and dealing with depression are important," he explains. "And then we make the resources available to these women."

Time for a Change

Each participant will get an individualized plan for education and implementation "that best meets her needs," Biggio says. And the team is optimistic that these plans will inspire long-term change. "Pregnancy is one of life's teachable moments," Biggio says. "The impact of any change is not just for the patient but for her child. Especially when we talk about things like substance abuse, it really lets us home in on the fact that smoking, for instance, is associated with fetal problems and stillbirth during pregnancy—and postnatally with respiratory issues, lung infections, and asthma.

"It's always hard to change any patient's behavior," Biggio says, "but pregnancy really is a unique opportunity."