Supplement - EMPOWR: Efforts to maximize perinatal outcomes in women at risk

Improving maternal-child health (MCH) is a national as well as a state priority. Compared to other US states, KY ranks among the highest in prevalence of preterm birth, lowbirth weight infants, smoking and substance abuse during pregnancy, and obesity in women of childbearing age. The University of Kentucky Department of Obstetrics and Gynecology and College of Nursing have selected perinatal health indicators that most impact pregnant women in Kentucky. The unique needs of these high-risk women require specialized attention when designing prenatal care services. These specific needs are intended to build on a social ecological model established with The March of Dimes sponsored Healthy Babies are Worth the WaitTM initiative. The enhanced centering model, Efforts to Maximize Perinatal Outcomes in Women at Risk (EMPOWR), will boost the existing CenteringPregnancy® (CP) model with a bundle preterm birth risk-reduction approach to further reduce incidence of adverse perinatal outcomes. EMPOWR will empower women via a self-management and peer support approach. Our strategy will integrate high-risk women into specialized centering-arms with specific attention on modifiable risk-reduction interventions. Five centering arms were identified to address the unique challenges pregnant women in Kentucky face. Specialized arms of the enhanced model include: 1) Tobacco Use/Substance Abuse; 2) Diabetes/Obesity; 3) Obstetrical/Medical Risk Factors; 4) Psychosocial factors, and 5) Hispanic Acculturation. Furthermore, all women will participate in a core prematurity prevention visit at 20-24 weeks gestation focusing on obstetrical history and cervical length assessment. The EMPOWR program has the capacity to improve perinatal outcomes and reduce the incidence of preterm birth in disproportionally affected regions across the state. We hope to bundle paradigms of care intended to reduce barriers to access, create equality in service, and improve quality by establishing uniformity of Best Practices.