Evaluating a multi-modal maternal infant perinatal outpatient delivery system: A randomized controlled trial (MOMI PODS RCT)

PROJECT SUMMARY United States (US) pregnancy-related mortality (PRM) has more than doubled over the last two decades, with an additional 1.5-fold post-pandemic rise. There are also striking socioeconomic, racial, and ethnic disparities US PRM. It’s estimated that 80% of US PRM is preventable, yet rates remain high and disparities remain wide. Roughly half of US PRM occurs postpartum (PP) after hospital discharge. During this period, cardiometabolic and mental health conditions are precipitating factors in most deaths. Such data is particularly alarming considering that only 60% of patients receive healthcare during the PP year and few patients receive care that is adherent to evidence-based guidelines, particularly after pregnancy affected by a cardiometabolic or mental health condition. This is perhaps not surprising considering that patients consistently report that, “after you have [a] baby, it’s all about the baby and you don’t have time for yourself.” And providers consistently report that the obstetric to PP primary care hand-off is challenging. Mothers with low socioeconomic status (SES) and from minoritized backgrounds are least likely to receive PP care but most likely to exhibit a major risk factor for PRM, which is driven by structural and individual racism and discrimination, including in healthcare. In collaboration with the Ohio Department of Medicaid, we designed a novel dyadic mother-infant PP primary care program targeted toward Medicaid-insured, minoritized patients transitioning out of high-risk pregnancy – the Multi-modal Maternal Infant Perinatal Outpatient Delivery System (MOMI PODS). Dyadic care is a critical component of the model, with mothers and infants cared for in tandem throughout the PP year, and beyond. MOMI PODS was also strategically designed to 1) facilitate a coordinated obstetric to PP primary care transition, 2) promote tailored, evidence-based care informed by the obstetric history, and 3) integrate clinical and supportive care to concurrently address clinical and psychosocial needs. We have now established 7 MOMI PODS sites and delivered MOMI PODS to >150 dyads. Our compelling preliminary data shows that MOMI PODS is feasible and acceptable, with patients attending 95% of visits that systematically incorporate clinical and supportive care. In the MOMI PODS hybrid type 1 randomized controlled trial (RCT), we’ll evaluate the effectiveness of MOMI PODS in mitigating PP cardiometabolic and mental health risk, identify the biopsychosocial mechanisms linking MOMI PODS to PP health, determine if MOMI PODS reduces disparities in PP care delivery, and identify strategies to improve implementation. Our central hypothesis is that MOMI PODS will mitigate PP risk and reduce disparities in PP risk by improving biopsychosocial profiles and facilitating access to evidence-based clinical and supportive care. Thus, the MOMI PODS RCT represents a critical step toward establishing an equitable, scalable model of integrative PP clinical and supportive care that is capable of mitigating PRM risk and addressing PRM disparities. MOMI PODS has significant potential to serve as a foundational model of care appropriate for scale up and replication in diverse healthcare settings.