Evidence-based recommendations to prevent preterm births include assessing patients’ risk levels and considering a variety of potential complications and health problems.

• Pregnant women are at greater risk of a preterm delivery if they have a chronic illness, such as diabetes, substance abuse, a history of preterm babies, live in an unsafe environment, and if they smoke.

• Case managers should engage with patients, including them and their families in decision-making and goal-setting.

• Goals might include improving nutrition, engaging in exercise, reducing stress, and obtaining social support.

New approaches to prevent preterm births and maternal morbidity and mortality are needed. Healthcare providers can initiate and improve maternal case management programs by following evidence-based techniques, says Susan Hines, RN, BSN, RN-BC, manager of clinical care services with Optima Health in Virginia Beach, VA.

Updated approaches are needed because much of the current treatments to prevent preterm births are ineffective, Hines says.

Case managers can use these best practices:

• Assess risk for preterm birth. Women at higher risk of preterm birth include women with twins and multiple gestations, and African American women. There are a variety of additional risk factors, according to the pregnancy care management standardized plan of North Carolina Public Health. (The plan can be found at: http://bit.ly/3apYcJ5.)

Additional risks, as outlined in the plan, include:

- Fetal complications;

- Chronic conditions, such as diabetes;

- Substance use/abuse;

- History of preterm birth;

- History of low birth weight baby;

- Unsafe living environment, including physical abuse, homelessness;

- Smoking;

- Late entry into prenatal care (after 14 weeks);

- Hospital utilization during pregnancy;

- Provider request for care management.

• Interact with patients frequently. Research shows that there are fewer low birth weight infants among women who received a higher level of prenatal case management. (More information can be found at: http://bit.ly/2PFLI8s.)

• Engage patients. Case managers can coordinate and communicate between the prenatal care team and patients. They also can educate patients about options, community resources, and psychosocial concerns.

Case managers can empower patients’ problem-solving and encourage the use of healthcare services to improve care quality. Health promotion includes encouraging women to engage in healthy behaviors, Hines says.

• Assign goals. Maternity case managers can develop a care plan that includes input from patients, families, prenatal care providers, and other service providers. The plan can assign goals that the patient agrees to work on with the care manager. It also should include periodic status and goal reviews with the patient at least every 90 days.

Health promotion includes encouraging women to engage in healthy behaviors, Hines says. Goals could involve asking pregnant women to agree to better nutrition, exercise, stress reduction, and social support, she adds.