Effects of state-level initiatives to reduce early-term elective deliveries on maternal and newborn outcomes - Project Summary This Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship will provide the trainee, an Epidemiology PhD student at UCSF, with mentored training essential achieving the applicant’s career goal of becoming a perinatal epidemiologist with expertise in health policy and health services research. Her training goals are to gain expertise in perinatal epidemiology and outcomes research, advanced quasi- experimental approaches for health policy research, and methods to measure effects on health disparities. To improve maternal and newborn outcomes, several US states have implemented numerous state-level initiatives and policies in recent decades. One set of initiatives were focused on reducing rates of early-term elective deliveries (EEDs) – non-medically indicated labor inductions and c-sections occurring before 39 weeks gestational age. EEDs are associated with significant increases in the risk of several newborn complications and neonatal intensive care unit admission. Studies thus far have found mixed results on the effects of initiatives on newborn outcomes, and frequently exclude endpoints for maternal outcomes and disparities in outcomes. Studies thus far are also hindered by data sources that misclassify EEDs and methodologic limitations that do not allow for generalizability or comparison between EED initiative types. The goal of the proposed research is to leverage a robust dataset to rigorously evaluate the effects of EED initiatives on maternal and newborn outcomes. Building on the applicant’s previous perinatal outcomes research and experience with the proposed dataset, this study will investigate and compare the effects of different state-level EED initiatives on healthcare utilization and perinatal (maternal and newborn) outcomes (Aim 1) and effects of these EED initiatives on disparities in outcomes, including by maternal race and ethnicity (Aim 2). Evidence and methodologic advancements from this study will inform further implementation and evaluation of state-level perinatal care initiatives. The proposed research is an ideal opportunity for the applicant to receive mentored training on recent innovations in quasi-experimental designs that will help overcome limitations of previous studies. The proposed training plan includes mentorship from experts and leaders in the in fields of perinatal epidemiology and outcomes research, comparative effectiveness studies, health services and policy research, social and structural determinants of perinatal outcomes, and clinical care. Research and training in this fellowship proposal are feasible and appropriate for the applicant’s current expertise and future goals. This fellowship will provide the applicant with the content knowledge, methodologic skills, and hands-on mentored experience to lay the foundation for an independent research career focused on holistically evaluating the effects of health services and policy changes on maternal and newborn outcomes. This training is critical to the applicant’s long-term goal, and NICHD priorities, to conduct research that helps to improve pregnancy outcomes and ensure lifelong wellness for mothers and their infants.
