{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:42:54Z","timestamp":1767796974321,"version":"3.49.0"},"reference-count":47,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["U54HD113291"],"award-info":[{"award-number":["U54HD113291"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,4]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Compared with other high-income countries, the USA continues to have the highest rates of pregnancy-related and associated mortality and morbidity (PRAMM), particularly in rural areas and among non-Hispanic black pregnancies. Over 80% of pregnancy-related deaths are preventable; however, the intensity of existing interventions has proven difficult to broadly disseminate. Technology offers the potential to address such barriers. This study will develop a multilevel digital intervention to reduce PRAMM and evaluate its effects using a site-randomised trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The Michigan Healthy Mom (MI MOM) intervention will be developed using a community-partnered approach and will seek to address PRAMM risks at four distinct levels: individual, support system, provider and community. Pregnant participants and up to three members of their personal support system will receive an initial brief interactive session through a mobile web app and will thereafter receive a series of text messages with links to extended content. Healthcare providers will receive biweekly text messages and\/or flyers distributed in clinic staff areas, and community health workers\u2014who can facilitate access to local services\u2014will be available via secure live chat text access. MI MOM effects will be evaluated using a cluster-randomised trial in 10 antenatal care clinics throughout Michigan (N=500 pregnant participants aged 18+ years receiving Medicaid). We will compare intervention and control arms on two coprimary outcomes: total PRAMM through 1 year post partum as measured using a universally collected linked dataset of Medicaid claims and vital records and an index of PRAMM risk factors directly targeted by MI MOM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Michigan State University Institutional Review Board has provided ethical approval (STUDY00011005). Results will be disseminated via presentations at academic conferences and community forums, as well as publications in peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07213284\">NCT07213284<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113340","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T19:10:22Z","timestamp":1766344222000},"page":"e113340","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Site-randomised trial of a multilevel digital intervention to reduce maternal morbidity and mortality: a study protocol"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct07213284","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07213284","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4679-1173","authenticated-orcid":false,"given":"Sydney S","family":"Kelpin","sequence":"first","affiliation":[{"name":"Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0692-2252","authenticated-orcid":false,"given":"Claire E","family":"Margerison","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5845-0107","authenticated-orcid":false,"given":"Athena S","family":"McKay","sequence":"additional","affiliation":[{"name":"Flint Innovative Solutions, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Vickers","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8231-5628","authenticated-orcid":false,"given":"Mary Katherine","family":"Crawford","sequence":"additional","affiliation":[{"name":"Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessie","family":"Spencer","sequence":"additional","affiliation":[{"name":"Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4121-1627","authenticated-orcid":false,"given":"Alla","family":"Sikorskii","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1134-7723","authenticated-orcid":false,"given":"Steven J","family":"Ondersma","sequence":"additional","affiliation":[{"name":"Charles Stewart Mott Department of Public Health and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,21]]},"reference":[{"key":"2026010703480156000_15.12.e113340.1","unstructured":"The U.S. maternal mortality crisis continues to worsen: an international comparison. 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