Very Preterm Birth is Reduced in Women Receiving an Integrated Behavioral Intervention: A Randomized Controlled Trial
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This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks (smoking, environmental tobacco smoke exposure (ETSE), depression, and intimate partner violence (IPV)) in African-Americans is associated with improved pregnancy outcomes. A randomized controlled trial targeting risks during pregnancy was conducted in the District of Columbia. African-American women were recruited if reporting at least one of the risks mentioned above. Randomization to intervention or usual care was site and risk specific. Sociodemographic, health risk and pregnancy outcome data were collected. Data on 819 women, and their singleton live born infants were analyzed using an intent-to-treat approach. Bivariate analyses preceded a reduced logistical model approach to elucidate the effect of the intervention on the reduction of prematurity and low birth weight. The incidence of low birthweight (LBW) was 12% and very low birthweight (VLBW) was 1.6%. Multivariate logistic regression results showed that depression was associated with LBW (OR = 1.71, 95% CI = 1.12–2.62). IPV was associated with preterm birth (PTB) and very preterm birth (VPTB) (OR 1.64, 95% CI = 1.07–2.51, OR = 2.94, 95% CI = 1.40–6.16, respectively). The occurrence of VPTB was significantly reduced in the intervention compared to the usual care group (OR = 0.42, 95% CI = 0.19-0.93). Our study confirms the significant associations between multiple psycho-behavioral risks and poor pregnancy outcomes, including LBW and PTB. Our behavioral intervention with demonstrated efficacy in addressing multiple risk factors simultaneously reduced VPTB within an urban minority population.
KeywordsAfrican-American Birth weight Pregnancy Gestational age
The authors wish to thank the field work staff, the interviewers, and data management staff. We wish to thank the participants who welcomed us into their lives in hopes of helping themselves and their children.
This study was supported by grants no. 3U18HD030445; 3U18HD030447; 5U18HD31206; 3U18HD031919; 5U18HD036104, National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
- 1.Mathews, T. J., & MacDorman, M. F. (2008). Infant mortality statistics from the 2005 period linked birth/infant death data set. National vital statistics reports, Vol. 57 no 2. Hyattsville, MD: National Center for Health Statistics.Google Scholar
- 5.Serenius, F., Ewald, U., Farooqi, A., Holmgren, P. A., Håkansson, S., & Sedin, G. (2004). Short-term outcome after active perinatal management at 23–25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors. Acta Paediatrica, 93(7), 945–953.CrossRefPubMedGoogle Scholar
- 6.Serenius, F., Ewald, U., Farooqi, A., Holmgren, P. A., Håkansson, S., & Sedin, G. (2004). Short-term outcome after active perinatal management at 23–25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: infant survival. Acta Paediatrica, 93(8), 1081–1089.CrossRefPubMedGoogle Scholar
- 8.Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Kirmeyer, S., & Munson, M. L. (2007). Births: Final data for 2005, National vital statistics reports, Vol 56, no 6. Hyattsville, MD: National Center for Health Statistics.Google Scholar
- 14.Joseph, J. G., El-Mohandes, A. A. E., Kiely, M., El-Khorazaty, M. N., Gantz, M. G., Johnson, A. A., et al. (2009). Results of a randomized clinical Trial in high-risk pregnant African-American women to reduce psychosocial and behavioral risk factors in pregnancy. American Journal of Public Health, 99(6), 1053–1061.CrossRefPubMedGoogle Scholar
- 17.Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2004). Effects of domestic violence on preterm birth and low birth weight. Acta Obstetrica Gynecologica Scandanavica, 83(5), 455–460.Google Scholar
- 18.Phares, T. M., Morrow, B., Lansky, A., Barfield, W. D., Prince, C. B., Marchi, K. S., et al. (2004). Surveillance for disparities in maternal health-related behaviors—selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2001. Morbidity and Mortality Weekly Report, 53(4), 1–13.Google Scholar
- 19.U.S. Department of Health and Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.Google Scholar
- 20.American College of Obstetricians, Gynecologists. (2000). Psychosocial risk factors: perinatal screening and intervention. International Journal of Gynaecology and Obstetrics, 69, 195–200.Google Scholar
- 25.Berkowitz, G. S., & Papiernik, E. (1993). Epidemiology of preterm birth. Epidemiological Review, 15, 414–443.Google Scholar
- 26.Whitehead, N. (2008). The relationship between individual life events and preterm delivery. RTI Press publication No. RR-0003-0809. Research Triangle Park, NC: RTI International. Retrieved 02/06/09 from http://www.rti.org/rtipress.
- 29.EI-Khorazaty, M. N., Johnson, A. A., Kiely, M., El-Mohandes, A. A. E., Subramanian, S., Laryea, H. A., et al. (2007). Recruitment and retention of low-income minority women in a behavioral intervention to reduce smoking, depression, and intimate partner violence during pregnancy. Biomedical Central Public Health, 7, 233.Google Scholar
- 30.Katz, K. S., Blake, S. M., Milligan, R. A., Sharps, P. W., White, D. B., Rodan, M. F., et al. (2008). The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women. Biomedical Central Pregnancy and Childbirth, 8, 22.CrossRefGoogle Scholar
- 31.Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
- 32.DiClemente, C. C., Prochaska, J., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59(2), 295–304.CrossRefPubMedGoogle Scholar
- 35.Dutton, M. A. (1992). Empowering and Healing Battered Women. New York: Springer.Google Scholar
- 36.Kung, H.-C., Hoyert, D. L., Xu, J., & Murphy, S. L. (2008). Deaths: Final data for 2005. National Vital Statistics Reports. vol. 56, no. 10.Google Scholar