1 MSS Prenatal Targeted Risk Factor Matrix MSS Risk Factor Definition Desired Outcome Rationale for Risk Factor Risk Factor Criteria Term birth greater than or African American and Black A. Not an option for this risk factor equal to (≥) 37 weeks women have a significantly B. Not an option for this risk factor gestation higher risk for LBW and C. American Indian, Alaska Native or Infant weighing greater than preterm birth. In addition, non-Spanish speaking indigenous or equal to (≥) 5 pounds 8 currently known risk factors women from the Americas (see Client (woman) identifies ounces associated with LBW/preterm definition) herself as: birth do not capture all Or African American women at African American or Black risk. African American or Black Or American Indian, Alaska American Indians or Alaska Native, or non-Spanish Natives (as a population) Pacific Islander Race speaking indigenous have more risk factors women from the Americas associated with LBW/preterm (e.g. women whose birth than other populations primary language is in this state. Mixteco, Mam, or Kanjobal, etc.) Pacific Islanders have the lowest rates among all racial Pacific Islander groups for seeking prenatal care in the first trimester. They also have the second highest rate of preterm births behind African Americans. Prenatal care initiated Early prenatal care provides A. Greater than or equal to (≥) 14 and before 14 weeks gestation important medical assessment less than (<) 24 weeks gestation and Prenatal care initiated including ultrasound and no prenatal care started at time of Late Entry prenatal care - within 1 month of starting blood and urine tests. Early screening. women greater than or equal to MSS care is important to identify B. Greater than or equal to (≥) 24 weeks Prenatal Care (≥) 14 weeks gestation and no more accurate gestational age gestation before prenatal care started prenatal care is established at of the fetus and any possible Or the time of screening problems. Late entry can also Greater than or equal to (≥)24 weeks be an indicator of other risk gestation and no prenatal care has factors associated with poor been started birth outcomes. C. Not an option for this risk factor Accessing WIC and food Food insecurity places A. Runs out of food before the end of the resources women at high risk for poor month or cuts down on food to feed nutrition (malnutrition, others Food insecurity- Runs out of anemia), weight gain issues, B. Not an option for this risk factor food before the end of the chronic stress, depression, C. Not an option for this risk factor Nutrition Food insecurity month or cuts down on amount and inability to address other eaten to feed others issues in her life including medical appointments and health conditions. Revised 12/16/2014 - MSS Prenatal Risk Matrix 2 MSS Prenatal Targeted Risk Factor Matrix MSS Risk Factor Definition Desired Outcome Rationale for Risk Factor Risk Factor Criteria Total pregnancy weight gain Underweight women are four *A. Pre-pregnancy BMI less than (<) 18.5 within Institute of Medicine times more likely to deliver a but pregnancy weight gain within (IOM) recommendation based low birth weight and/or guidelines (see desired outcome Pre-pregnancy BMI less than on Pre-pregnancy BMI: preterm infant regardless of column) (<) 18.5 pregnancy weight gain. B. Not an option for this risk factor Singleton Birth – 28 to 40 *C. Pre-pregnancy BMI less than (<) 18.5 Pre-pregnancy Body Mass pounds total for the Women who gain less than and inadequate weight gain based on Index (BMI) classified as pregnancy. Approximately the Institute of Medicine’s guidelines (see desired outcome underweight (less than < 18.5 1+ pound a week starting in guidelines are at 6 times the column) BMI) the second trimester. risk. Research shows that women who eat a quality diet Use CDC BMI table for adults Multiples - no set and gain within IOM guideline. Approximately recommendations have better 40+ pounds total. birth outcomes. Weight gain within IOM Women with a pre-pregnancy A. Pre-pregnancy BMI 25.0 to 29.9 (See recommendation based on Pre- BMI 25.0 to 29.9 are twice as desired outcome column) Pre-pregnancy BMI 25 to 29 pregnancy BMI: likely to develop diabetes and B. Not an option for this risk factor hypertension than women C. Not an option for this risk factor Pre-pregnancy Body Mass Singleton birth – 15 to 25 who start out in the normal Index (BMI) classified as pounds total for the BMI range pre-pregnancy. overweight (Pre-pregnancy Pre-pregnancy pregnancy. Approximately Nutrition BMI 25.0 to 29.9) BMI 1/2 pound a week starting second trimester Use CDC BMI table for adults Multiple Birth - 31to 50 pounds total Weight gain within IOM Women with a pre-pregnancy *A. Pre-pregnancy BMI greater than or recommendation based on Pre- BMI greater than or equal to equal to (≥) 30.0 and pregnancy pregnancy BMI: (≥) 30.0 are more than twice weight gain within guidelines (See as likely to have a poor birth desired outcome column) Singleton Birth - outcome regardless of Pre-pregnancy BMI greater *B. Pre-pregnancy BMI greater than or 11-20 pounds total for the pregnancy weight gain. That equal to (≥) 30.0 and weight gain not than or equal to( ≥) 30 risk increases with the pregnancy with women who within guidelines (see desired increase in BMI (40 BMI = 8 Pre-pregnancy Body Mass are high in BMI gaining at outcome column) times the risk). Index (BMI) classified as obese the lower end of the weight C. Not an option for this risk factor (Pre-pregnancy BMI greater gain range Obese women are twice as than and equal to( ≥) 30.0) Approximately 1/2 pound a likely to have a stillbirth, week starting second fetal abnormality, and Use CDC BMI table for adults trimester 4 pounds or less the first preterm birth due to trimester metabolic changes that include glucose intolerance Multiples - 25 to 42 pounds (separate from GDM) and lipid metabolism. Revised 12/16/2014 - MSS Prenatal Risk Matrix 3 MSS Prenatal Targeted Risk Factor Matrix MSS Risk Factor Definition Desired Outcome Rationale for Risk Factor Risk Factor Criteria Term birth greater than or Shorten Interval between A. Current pregnancy conception less Period between end of last equal to (≥) 37 weeks pregnancies does not allow than (<) 9 months from end of last pregnancy and current gestation for the woman’s body to pregnancy Inter-pregnancy Interval less pregnancy is less than (<) 9 than 9 months Infant born weighing return to the most optimum B. Not an option for this risk factor months. (This includes greater than or equal to (≥) physiologic/nutrition status C. Not an option for this risk factor miscarriages, terminations) 5 pounds 8 ounces before pregnancy. Stable blood sugars: Type 1 or 2 diabetes places A. Not an option for this risk factor Diabetic Type 1 or 2 Fasting 60mg -100mg/dl women at risks for fetal loss, B. Not an option for this risk factor 1hr postprandial 100-140 mg/dl stillbirth, depression, C. Diabetic Type 1 or 2 Diabetes diagnosed prior to 2hr postprandial <120 mg/dl hypo/hyperglycemia, pregnancy: Before Bed 100-120mg/d increased risk of infection, c- section and preterm birth. Weight gain within Institute Type 1 is an insulin Diabetes of Medicine (IOM) guidelines Infants are at higher risk for dependent diabetic fetal death/stillbirth, birth based on Pre-pregnancy BMI: Example for singleton defects, jaundice, Type 2 is diet controlled <18.5 BMI: 28-40 lbs hypoglycemia, macrosomia, and possibly taking oral 18.5 to 24.9 BMI: 25-35 lbs diabetes later in life. medication 25.0 -29.9 BMI: 15-25 lbs ≥30.0 BMI: 11-20 lbs Stable blood sugars: Gestational diabetes places A. Not an option for this risk factor Fasting 60mg-100mg/dl women at risk for preterm B. History of gestational diabetes with 1hr postprandial 100-140 mg/dl birth, depression, infection, last pregnancy and diabetes in the future. C. Gestational diabetes with current Medical Gestational Diabetes: 2hr postprandial <120 mg/dl Pregnant women who did not pregnancy have diabetes prior to Before Bed 100-120mg/d Infants are at higher risk for pregnancy but have been jaundice, hypoglycemia, Gestational diagnosed by a medical Weight gain within Institute macrosomia, and later in life Diabetes provider to have high blood of Medicine (IOM) guidelines diabetes. sugar (glucose) levels during based on Pre-pregnancy pregnancy (determined by BMI: Example for singleton glucose tolerance test) <18.5 BMI: 28-40 lbs 18.5 to 24.9 BMI: 25-35 lbs 25.0 -29.9 BMI: 15-25 lbs ≥30.0 BMI: 11-20 lbs Delivery greater than or equal Multiple fetuses have the A. Not an option for this risk factor to (≥) 37 weeks gestation. highest incidence of B. Not an option for this risk factor Multiple Pregnant with more than one preterm/low birth rate and C. Current pregnancy with multiple Gestation fetus many other poor birth fetuses outcomes for both mother and infant. Revised 12/16/2014 - MSS Prenatal Risk Matrix 4 MSS Prenatal Targeted Risk Factor Matrix MSS Risk Factor Definition Desired Outcome Rationale for Risk Factor Risk Factor Criteria Chronic high blood pressure Blood pressure less than or Chronic high blood pressure A. Gestational Hypertension in past (BP): BP screening greater equal to (≤) 120/80; and PIH/GH places a woman pregnancy. than or equal to (≥) 140/90 at Following prescribed care at high risk for preeclampsia, B. Not an option for this risk factor more than one reading which by medical provider preterm birth and adverse C. Chronic Hypertension and Pregnancy started before the woman Following diet and exercise birth outcomes.