PREGNANCY PASSPORT The pathway to health for you and your baby

The Pregnancy Passport is a condensed, bilingual handheld medical record that also includes critical information on signs and symptoms of premature labor, important prenatal health information and helps women to become more involved in their prenatal care. Researchers worldwide have documented the importance of empowering pregnant women to recognize danger signs and symptoms during pregnancy. Recognition of these signs is a critical first step in seeking timely emergency care.

The Pregnancy Passport was developed and pilot tested in 2003 with women at five UCSD prenatal care sites in San Diego. The program is funded by a community grant from the Southern California March of Dimes and is managed by San Diego and Imperoal Counties Regional Perinatal System. The ultimate goal of the program is to reduce the infant mortality rate in San Diego and Imperial Counties.

Pregnancy Passport Program Goals

• To enhance access to critical prenatal medical information (such as blood type, HIV status and other prenatal lab results) through the use of a handheld medical record, the Pregnancy Passport
• To increase screening for risk factors and awareness of warning signs for premature labor and high-risk pregnancy complications
• To empower women through increased knowledge and involvement in their own care
• To improve the quality of patient services aimed at reducing preterm labor, prolonging gestation and providing necessary medical interventions

Program Overview
The Pregnancy Passport is an important resource for pregnant women and their health care providers. The program primarily addresses two problems that impact the health status of pregnant women and infants in San Diego County:

• Lack of familiarity among pregnant women with the risk factors and signs and symptoms of premature labor, which often prevents them from seeking appropriate care and contributes to premature births; and
• Barriers to appropriate clinical care that occur when a woman’s prenatal record is not available to the health care provider, particularly in emergency situations, such as when preterm labor occurs.

Both of these problems were identified and documented through the County of San Diego Fetal and Infant Mortality Review (FIMR) process.

Background on Prematurity
A full term pregnancy lasts between 37 and 42 weeks. Babies born before 37 completed weeks or pregnancy are considered to be premature or preterm. Almost 12 percent of babies born in the US are born preterm. 10.2% of infants born in San Diego County and 11.9% in Imperial County were delivered preterm in 2000.

Babies born preterm face a greater risk of serious health problems, but those born the earliest are at an even greater risk of long-term disability and death. Premature infants are 14 times more likely to die in the first year of life than babies born full term. For the African-American population, prematurity is the leading cause of infant mortality. In San Diego County, prematurity is second only to birth defects as the cause of infant deaths, accounting for about 21% of infant deaths.

Sometimes a baby is delivered preterm because a doctor induces labor due to pregnancy complications or problems with the mother’s health. But most of the time preterm births are the result of preterm labor. The causes of preterm labor are not fully understood, but it is vital for women to be aware of preterm labor signs and to notify their prenatal care provider as soon as possible if they are experiencing any of these signs. The sooner a doctor suspects a woman may be going into preterm labor, the more the doctor can do to postpone labor and arrange for appropriate delivery and care of a premature infant.

Fetal and Infant Mortality Review (FIMR) case reviews in San Diego County found that about 50% of the women whose babies died due to prematurity did not recognize or understand the severity of their symptoms when they experienced preterm labor. In many instances, women delayed seeking care, thereby reducing the medical provider’s window of opportunity to offer appropriate intervention.

Fortunately, medical advances have made it possible for hospitals to improve the chances of survival for premature babies. But even when the preterm baby survives, the health, social and financial impact can be great. For example, in 2000, the average US hospital charge was $58,000 per pre-term baby, compared to $4,300 for a typical newborn stay.

Currently, the March of Dimes is funding research to learn more the causes of prematurity and what can be done to prevent it. The Pregnancy Passport educates women about the signs of preterm labor with the overall goal of reducing infant death due to prematurity. For more information on prematurity, check out the March of Dimes website.

2003-2004 Pilot Sites

• UCSD Healthcare and Comprehensive Midwifery Care providers at:
  • Ambulatory Care Center
  • Comprehensive Health
  • Mid-City Community Clinic
  • Mira Mesa Family Practice
  • Perlman Ambulatory Care Center

Program Expansion Sites

• To be announced

Contact Information
Jessica Gorman, MPH

This material is for informational purposes only and does not constitute medical advice. The opinions expressed in this material are those of the author(s) and do not necessarily reflect the views of the March of Dimes.