MAMA's Neighborhood: Reimagining Prenatal Care to Support Mothers and Reduce Stress

Preterm birth is the leading cause of infant mortality. Black women are 48% more likely to have a preterm delivery than their non-Hispanic white counterparts and may experience social stressors that contribute to preterm birth risk, including experiences with racism, disproportionate effects of economic immobility, and sometimes housing instability, food insecurity, or exposure to community and police violence. The cumulative wear and tear of these stressors on the body is known as "allostatic load." To mitigate the effects of allostatic load on birth outcomes, the Los Angeles County (LAC) health system developed a novel prenatal care model titled MAMA's Neighborhood to organize prenatal care into a medical home model. MAMA's implemented structured prenatal intake assessments of mental health, substance use, housing/food insecurity, social support, and medical risk and then stratified groups to direct levels of care management and services. After starting with four initial sites in 2014, the program has grown to 10 sites across LAC Department of Health Services (DHS) prenatal clinics. They now serve 90% of all prenatal patients in the DHS system. During the demonstration, delivery volume increased by 21% at LAC DHS hospitals, and postpartum follow-up retention increased by 60%. The authors' data suggest that assessing and addressing allostatic load in pregnancy can reduce adverse pregnancy outcomes for patients at the highest risk of preterm birth, a critical step in addressing the current health equity gap. MAMA's represents a promising strategy that leverages multidisciplinary collaborative care with existing social services in the safety net to improve birth outcomes.