Duke Population Health Improvement Award
Preterm birth (PTB), delivery prior to 37 weeks gestation, is the leading cause of neonatal mortality and morbidity. The US PTB rate is 49% higher in black women. In women with a history of spontaneous PTB, randomized controlled trails demonstrate that weekly intra-muscular (IM) injections of 17-hydroxprogesterone caproate (17-P) reduce the risk of recurrent PTB by up to one third if started between 16-20 weeks gestation. Despite the evidence and clear guidelines, preliminary data from the Duke clinic suggests 20% of 17-P eligible patients present beyond the 20-week gestational age window recommended for starting the therapy. Additionally, over 50% of the women presenting beyond the window for 17-P are non-Hispanic Black (NHB). Given the increasing rate of PTB, persistent racial disparities and suboptimal 17-P utilization, it is imperative to identify patient-perceived, culturally-specific barriers and facilitators to timely presentation for prenatal care in women eligible for 17-P.