The maternal mortality rate in the United States, which has doubled in the past 20 years, is higher than in any other industrialized nation. At least half of these deaths are preventable, and many are driven by systemic racism and social determinants of health such as poor access to quality and culturally approtriate care, gaps in insurance coverage before pregnancy, food insecurity, housing, and others, researchers say. In 2021, Black pregnant women died at a rate 2.6 times higher than their White counterparts. Although Hispanic women experience relatively lower maternal mortality, this rate has jumped sharply in recent years, particularly during the COVID-19 pandemic.
To reverse this alarming trend, the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health (NIH), created the Maternal Health Community Implementation Project (MHCIP) in 2021. MHCIP engages communities to implement evidence-based interventions targeted at poor maternal outcomes such as hypertension, obesity, and gestational diabetes in minoritized populations.
As part of the four coalitions supported by MHCIP, NYU Langone's Institute for Excellence in Health Equity was awarded $12.5 million over five years with Natasha J. Williams, EdD, MPH, associate professor in the Department of Population Health, as principal investigator. The program will adapt and implement the Starting Early Program (StEP), an individual and group-based supportive nutrition and lifestyle counselling program for pregnant women. StEP was originally developed by two team members, Rachel S. Gross, MD, assistant professor in the Departments of Pediatrics and Population Health, and Mary J. Messito, MD, clinical associate professor in the Department of Pediatrics and an obesity medicine specialist at NYU Grossman School of Medicine.
Dr. Williams will lead the adaptation of StEP to meet unique needs of diverse patient populations and to facilitate implementation in low-income practices that serve minoritized populations. The newly adapted program, named JustMothers, will be delivered digitally by community health workers using culturally relevant text messaging and video links. Community health workers are lay members of a community, who have similar ethnicity, language, socioeconomic status, and/or life experiences with the people they serve.
"We are excited and honored to offer this first-of-its kind digital intervention to Black and Hispanic pregnant women in New York City, where there is a high burden of maternal health inequities," said Dr. Williams. "This research program enables us to move beyond descriptive accounts of health inequities by implementing practical and sustainable solutions to address the crisis of maternal morbidity. We are deeply appreciative to our community partners and people with lived experience who will play a critical role in not just our ability to engage with pregnant persons, but also in building lasting community engagement networks to achieve health equity. This grant will contribute to NYU Langone's efforts to promote maternal health equity and health justice."
Guided by a robust implementation science framework, the research team will evaluate adoption and dissemination of JustMothers across NYC Health + Hospitals, the largest municipal health system in the country, and the Family Health Centers at NYU Langone (one of the largest Federally Qualified Health Centers in New York State) in Sunset Park and Flatbush in Brooklyn, New York.
The Family Health Centers at NYU Langone has a longstanding commitment to providing comprehensive women's health services in Brooklyn. This proposal builds on that commitment to offer enhanced services to the pregnant people receiving care in Sunset Park, Brooklyn."
Isaac P. Dapkins, MD, chief medical officer of the Family Health Centers at NYU Langone
"We are so excited to work with our healthcare and community partners to adapt and implement this intervention on a large scale," said Dr. Messito. "Improved knowledge and support for healthy nutrition and lifestyle practices during pregnancy hold the potential to improve maternal outcomes and reduce health disparities."
"Addressing social determinants of health, such as food insecurity and unstable housing, is an essential part of addressing social justice and advancing the health equity of our pregnant and postpartum patients," said Wendy Wilcox, MD, MPH, MBA, chief women's health officer at NYC Health + Hospitals. "Nutrition is medicine—it can help manage or even reverse chronic conditions like high blood pressure and diabetes. We are proud to serve all New Yorkers, and we look forward to partnering with NYU Langone Health on this important study."
This first year of the award is dedicated to building the infrastructure to support the research. The investigators will enroll 900 pregant women. Enrollment will begin before December 2023.
Other members of the research team include Gbenga Ogedegbe, MD, MPH, professor of population health and director of the Institute for Excellence in Health Equity; Mary A. Sevick, ScD, professor of population health and medicine; Heather T. Gold, PhD, professor of population health; Erinn M. Hade, PhD, associate professor of population health; and Angela Aifah, PhD, assistant professor of population health. Community partners and advisors include the Northern Manhattan Perinatal Partnership, CAMBA (Church Avenue Merchant Block Association), SheMatters, and Caribbean Women's Health Association Inc.
Medical debt is associated with population health and increased mortality