Expertise in Indiana Health

Maternal Care

Among the five categories of infant mortality, the largest percentage of deaths (48.1 percent) occur as a result of perinatal risks. Smoking, obesity, lack of prenatal care, and other unhealthy habits are known as perinatal risks. These risk factors can lead to preterm birth, which is the official cause of death for many infant mortality cases. About 10 percent of live births are preterm, and they account for about two thirds of infant deaths.

Given the lack of positive impact on infant mortality after three decades of working to address perinatal risk by telling pregnant women not to smoke, to get prenatal care and so forth, medical educators and researchers are exploring other preconception factors, including family planning. After all, women with planned pregnancies are more likely to be nutritionally fit, engage in healthy behaviors and attend prenatal care. They are less likely to have preterm births.

Premature Delivery

Preterm birth is a significant risk factor for infant mortality, and mothers who have already had one preterm baby are more likely to have another premature delivery. Research exploring how to reduce preterm births found that weekly injections of 17 Alpha-Hydroxyprogesterone Caproate (250 mg)—from 16 weeks until delivery (or 36 weeks)—decreases the risk of recurrent preterm births by 30 to 40 percent. But a range of on-the-ground hurdles prevent universal adoption.

Healthcare-delivery system issues include how to identify eligible women and reach them with information about the treatment. Access to progesterone through local clinics and transportation to sites to receive the weekly injections also present barriers. Other issues relate to prior authorization requirements by payers and a lack of low-cost alternative (generic) to the brand drug.

IU School of Medicine Department of Pediatrics faculty are working with the Indiana Perinatal Quality Improvement Collaborative to implement quality improvement processes to eliminate access to 17 Alpha-Hydroxyprogesterone Caproate, including those related to prior authorization. This organization is a group of volunteers from all over the state. Nancy L. Swigonski, MD, professor of Pediatrics at IU School of Medicine, sits on the group’s governing council as a representative of the Indiana chapter of the American Academy of Pediatrics.

The group has developed a data collection tool to identify how many women begin this treatment but don’t complete the weekly injections, and why. The goal is to identify barriers and to develop systems to maximize the number of eligible women who receive the treatment. With funding from Riley Children’s Foundation and clinical collaboration with Eskenazi Hospital, this project is focusing on high-risk areas in Marion County.

Jeffrey F. Peipert, MD, PhD, is working with Riley Hospital for Children to implement a plan of decreasing barriers and increasing use of progesterone in pregnant women to decrease preterm birth.

Family Planning

Birth spacing is also an important aspect of family planning, as data shows that spacing births at least 18 months apart leads to healthier outcomes for mother and baby. IU School of Medicine faculty who specialize in adolescent medicine are examining how to streamline care to prevent unwanted pregnancies in Indiana.