P3B276: Improving Infant Health in the Delta Through Education and Research: A Pilot Study

Background: The United States ranked 33 out of 38 countries in 2020 for infant mortality. Within the U.S. there is variability in infant mortality across geographic regions, with the highest being in the Mississippi Delta. This project aimed to improve the health of infants living in the Delta region of Arkansas by both providing education to pregnant women and conducting research to identify barriers to optimal infant health.

Methods: We conducted prenatal classes for women living in the Delta region of Arkansas, covering topics such as breastfeeding, safe sleep, maternal health behaviors, and postpartum depression. Participants were asked to complete a survey during the first prenatal class and at 1, 3, and 6 months after the birth of their baby. Surveys covered topics including plans and practices for infant sleep, maternal health behaviors and social determinants of health. As an incentive, participants received a Walmart gift card for each completed survey. Due to the risks of COVID-19 to pregnant women, the classes were conducted virtually and the surveys and informed consent were conducted electronically. This project was approved by the IRB and funded by a CATCH grant from the AAP.

Results: Twenty women, residing in 9 counties in the Delta, consented to the study, attended the prenatal classes, and completed at least the first two surveys (Table 1). Finances, transportation, and food insecurity were common sources of difficulty. At the time of the initial survey, 35% had received a warning of utility termination within the past 12 months or had utilities disconnected. In addition, 35% reported lacking money to pay bills sometimes or often and 50% endorsed some degree of food insecurity. Forty percent traveled over 20 miles one way for prenatal care, 35% traveled 20 miles or more to reach the birth hospital and 20% over 50 miles. Overall, 20% had put off or neglected going to the doctor because of distance or transportation problems (Table 2). Regarding health behaviors, 45% of fetuses were potentially exposed to alcohol. Only 20% of mothers were taking folic acid supplementation prior to becoming pregnant and 15% were still not taking folic acid supplementation at the time of the initial survey. At baseline, 35% of participants reported that they intended to co-sleep with their infant, while another 20% were undecided. At the 1-month survey only 20% reported that they co-slept with their infant, indicating potential benefit from the prenatal safe sleep education.

Conclusion: Efforts to screen for and address social determinants of health-related issues, education about the dangers of alcohol exposure to the fetus and the importance of prenatal folic acid supplementation, and education about safe sleep practices may be worthwhile areas of focus in order to improve to health of infants in the Delta.