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


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.


African-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.

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.


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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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