Incidence of low birthweight in a hospital-based prenatal clinic: A quality assessment/quality improvement project

Abstract

The objective of the project was to monitor the incidence of LBW deliveries in a hospital-based prenatal clinic, and to develop protocols, using a multidisciplinary approach, to lower the number of such births. For six months, all patients (n=234) who registered for the clinic were evaluated for risk factors, inclusive of cigarette smoking, substance abuse (alcohol and/or drug use), anemia (hemoglobin [HGB] < 11.0 gm/dl). pregravid weight status as well as weight history, race and age. The clients were followed through 6 weeks post parium. At the end of the six months, the multidisciplinary team, consisting of a physician, dietitians, a dietetic technician, nurses, and an administrator met, and several problems were identified. (Refer to Table) Intervention plans were initiated for the next 6 months, consisting of mandatory drug screenings, aggressive counseling on substance abuse, enrollment in smoking cessation programs, development of iron supplementation protocol, frequent nutritional intervention to assure adequate weight gain, and utilization of educational videos shown during regular clinic hours to all clients. The results of the 6-month intervention trial are represented in the Table. There was a substantial decrease in the incidence of LBW post-intervention. Cigarrette use and substance abuse did decline as well. Anemia occurred in a slightly smaller number of clients; however, it still remained as a notable risk factor. This may be directly related to noncompliance with iron supplements. The number of inadequate weight gains dropped considerably. Race did not play a substantial role, may be secondary to the demographies of the clinic (75 % of the population is white/others. 25 % black). Although there are areas to further focus attention, this is an example of how a multidisciplinary approach was successful in improving maternal and fetal outcome.