Research-based policies, practices and programs

Policy solutions aimed at improving women’s pre-pregnancy health can help reduce low weight and preterm births.¹ This will require attention to such health issues as women’s oral health, diabetes, obesity, asthma, high blood pressure, smoking, substance use, depression, and other mental health challenges prior to pregnancy.

Women who have access to health insurance have healthier pregnancies and babies. More and better health care pre-pregnancy may prevent risk factors during pregnancy, including maternal smoking or limited prenatal care. States that have expanded Medicaid to cover all persons under 135% of the federal poverty level are likely to see increased rates of care and better birth outcomes.²

Pregnancy care should focus on elements of women’s health associated with low weight births. These include:

• Providing care early in a pregnancy
• Providing depression screening and clinical or home visiting
• Reducing elective deliveries
• Reducing or quitting substance use, including smoking cessation
• Managing weight gain
• Providing treatment for periodontal disease¹
    

Three of the ten strategies identified by the National Conference of State Legislatures (NCSL) to increase healthy births and improve the health of babies and their mothers directly focus reducing low weight births, including:

• Promote early, high quality prenatal care. States should assess needs and develop improvement plans, educate women about healthy pregnancies through education and outreach, and target high-risk Medicaid enrollees.
• Reduce early elective deliveries. States should form perinatal health collaboratives, use incentives for physicians, and pass laws to reduce early elective deliveries. Outcomes for babies improve and costs to the state go down.
• Promote evidence-based home visiting. States should offer home visiting as an enhanced prenatal Medicaid benefit. Evidence-based home visiting programs have been shown to improve expectant mothers’ prenatal health. The Nurse Family Partnership, for example, has been shown to reduce tobacco use while pregnant, improve diet and nutrition, and improve cardiovascular and kidney health.²

Research on health outcomes has found that the ideal minimum spacing between pregnancies is between 18-23 months. Shorter intervals increase risk of health concerns for mothers and babies. An interval of less than six months increases the likelihood of low birthweight delivery by 40%.¹ Offering voluntary, long-lasting, reversible contraception at or soon after delivery has been found to reduce subsequent high-risk births.²
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Smoking while pregnant increases the risk of low birthweight and preterm birth. Evidence-based practices for medical providers to help people quit smoking include:

• Routinely screening all adults for tobacco use
• Encouraging smokers to quit at every clinical contact
• Providing motivational interventions for patients not yet ready to quit smoking
• Encouraging medications when appropriate to treat dependence and improve the quit rate¹
• Following up with the patient²

A group approach to prenatal care brings a small group of pregnant mothers together to meet with their doctor and each other. Programs like CenteringPregnancy allow moms to:

• Develop a relationship with their healthcare providers
• Strengthen social connections with other mothers
• Learn more about their own health and that of their babies

Each group visit is 90 minutes to two hours long and includes health assessments, private time with the doctor, and interactive group discussions or activities addressing relevant health topics.¹

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A doula is a trained birthing support person who provides medically accurate information to women, helps create a birthing plan, and supports women physically and emotionally throughout the birthing process. Doula-assisted women are four times less likely to have low weight births.¹ This support is also associated with lower neonatal intensive care unit rates, fewer Caesarian births, and more positive birth experiences.²

CBT is an evidence-based mental health treatment that helps individuals change their cognitive frames—the way we act, feel, think, and deal with problems. Hundreds of studies have shown CBT to be effective in substance use and smoking disorders, depression and anxiety, and post-traumatic stress disorders. CBT therapists focus on the current situation and its solution over a multi-session period.¹