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Maternal and Child Health Journal

, Volume 15, Issue 1, pp 19–28 | Cite as

Very Preterm Birth is Reduced in Women Receiving an Integrated Behavioral Intervention: A Randomized Controlled Trial

  • Ayman A. E. El-Mohandes
  • Michele Kiely
  • Marie G. Gantz
  • M. Nabil El-Khorazaty
Article

Abstract

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.

Keywords

African-American Birth weight Pregnancy Gestational age 

Notes

Acknowledgments

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.

Financial disclosure

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.

References

  1. 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
  2. 2.
    Callaghan, W. M., MacDorman, M. F., Rasmussen, S. A., Qin, C., & Lakritz, E. M. (2006). The contribution of preterm birth to infant mortality rates in the United States. Pediatrics, 118(4), 1566–1573.CrossRefPubMedGoogle Scholar
  3. 3.
    Dominguez, T. P. (2008). Race, racism, and racial disparities in adverse birth outcomes. Clinical Obstetrics and Gynecology, 51, 360–370.CrossRefPubMedGoogle Scholar
  4. 4.
    Reagan, P. B., & Salsberry, P. J. (2005). Race and ethnic differences of preterm birth in the USA: Broadening the social context. Social Science and Medicine, 60, 2217–2228.PubMedGoogle Scholar
  5. 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. 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
  7. 7.
    Shankaran, S., Fanaroff, A. A., Wright, L. L., Stevenson, D. K., Donovan, E. F., Ehrenkranz, R. A., et al. (2002). Risk factors for early death among extremely low-birth-weight infants. American Journal of Obstetrics and Gynecology, 186(4), 796–802.CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    Nguyen, D. P., Genc, M., Vardhana, S., Babula, O., Onderdonk, A., & Witkin, S. S. (2004). Ethnic differences of polymorphisms in cytokine and innate immune system genes in pregnant women. Obstetrics and Gynecology, 104(2), 293–300.CrossRefPubMedGoogle Scholar
  10. 10.
    Wang, X., Zuckerman, B., Pearson, C., Kaufman, G., Chen, C., Wang, G., et al. (2002). Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. Journal of the American Medical Association, 287(2), 195–202.CrossRefPubMedGoogle Scholar
  11. 11.
    Gonzalez-Calvo, J., Jackson, J., Hansford, C., & Woodman, C. (1998). Psychosocial factors and birth outcome: African American women in case management. Journal of Health Care for the Poor and Underserved, 9, 395–419.PubMedGoogle Scholar
  12. 12.
    Ricketts, S. A., Murray, E. K., & Schwalberg, R. (2005). Reducing low birthweight by resolving risks: results from Colorado’s Prenatal Plus Program. American Journal of Public Health, 95, 1952–1957.CrossRefPubMedGoogle Scholar
  13. 13.
    Zimmer-Gembeck, M. J., & Helfand, M. (1996). Low birthweight in a public prenatal care program: Behavioral and psychosocial risk factors and psychosocial intervention. Social Science and Medicine, 43, 187–197.CrossRefPubMedGoogle Scholar
  14. 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
  15. 15.
    El-Mohandes, A. E., Kiely, M., Joseph, J. G., Subramanian, S., Johnson, A. A., Blake, S. M., et al. (2008). An intervention to improve postpartum outcomes in African American mothers: A randomized controlled trial. Obstetrics and Gynecology, 112(3), 611–620.CrossRefPubMedGoogle Scholar
  16. 16.
    Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S., Kuhn, C., Yando, R., et al. (2003). Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate. Depression and Anxiety, 17(3), 140–151.CrossRefPubMedGoogle Scholar
  17. 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. 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. 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. 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
  21. 21.
    Durant, T., Colley Gilbert, B., Saltzman, L. E., & Johnson, C. H. (2000). Opportunities for intervention: discussing physical abuse during prenatal care visits. American Journal of Preventive Medicine, 19, 238–244.CrossRefPubMedGoogle Scholar
  22. 22.
    Berkowitz, G. S. (1981). An epidemiologic study of preterm delivery. American Journal of Epidemiology, 113, 81–92.PubMedGoogle Scholar
  23. 23.
    Culhane, J., & Elo, I. T. (2005). Neighborhood context and reproductive health. Journal of Obstetrics and Gynecology, 192(Suppl 1), S22–S29.CrossRefGoogle Scholar
  24. 24.
    Wingate, M. S., Swaminathan, S., & Alexander, G. R. (2009). The influence of maternal mobility on birth outcomes of non-Hispanic Blacks. Maternal and Child Health Journal, 13, 48–55.CrossRefPubMedGoogle Scholar
  25. 25.
    Berkowitz, G. S., & Papiernik, E. (1993). Epidemiology of preterm birth. Epidemiological Review, 15, 414–443.Google Scholar
  26. 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.
  27. 27.
    Lightwood, J. M., Phibbs, C. S., & Glantz, S. A. (1999). Short-term and Economic benefits of smoking cessation: Low birth weight. Pediatrics, 104(6), 1312–1320.CrossRefPubMedGoogle Scholar
  28. 28.
    Norbeck, J. S., DeJoseph, J. F., & Smith, R. T. (1996). A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women. Social Science and Medicine, 43(6), 947–954.CrossRefPubMedGoogle Scholar
  29. 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. 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. 31.
    Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  32. 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
  33. 33.
    Miranda, J., & Munoz, R. (1994). Intervention for minor depression in primary care patients. Psychosomatic Medicine, 56(2), 136–141.PubMedGoogle Scholar
  34. 34.
    Parker, B., McFarlane, J., Soeken, K., Silva, C., & Reel, S. (1999). Testing an intervention to prevent further abuse to pregnant women. Research in Nursing and Health, 22, 59–66.CrossRefPubMedGoogle Scholar
  35. 35.
    Dutton, M. A. (1992). Empowering and Healing Battered Women. New York: Springer.Google Scholar
  36. 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
  37. 37.
    Schempf, A. H., Branum, A. M., Lukacs, S. L., & Schoendorf, K. C. (2007). The contribution of preterm birth to the black–white infant mortality gap, 1990 and 2000. American Journal of Public Health, 97, 1255–1260.CrossRefPubMedGoogle Scholar
  38. 38.
    Nadeau, L., Tessier, R., Boivin, M., Lefebvre, F., & Robaey, P. (2003). Extremely premature and very low birthweight infants: A double hazard population? Social Development, 12(2), 235–248.CrossRefGoogle Scholar
  39. 39.
    Lee, E., Mitchell-Herzfeld, S. D., Lowenfels, A. A., Greene, R., Dorabawila, V., & DuMont, K. A. (2009). Reducing low birth weight through home visitation: A randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154–160.CrossRefPubMedGoogle Scholar

Copyright information

© US Government 2010

Authors and Affiliations

  • Ayman A. E. El-Mohandes
    • 1
  • Michele Kiely
    • 2
  • Marie G. Gantz
    • 3
  • M. Nabil El-Khorazaty
    • 3
  1. 1.College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Epidemiology, Statistics and Prevention ResearchEunice Kennedy Shriver National Institute of Child Health and Human Development/NIHBethesdaUSA
  3. 3.Statistics and Epidemiology UnitRTI InternationalRockvilleUSA

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