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An Integrated Randomized Intervention to Reduce Behavioral and Psychosocial Risks: Pregnancy and Neonatal Outcomes

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Abstract

While biomedical risks contribute to poor pregnancy and neonatal outcomes in African American (AA) populations, behavioral and psychosocial risks (BPSR) may also play a part. Among low income AA women with psychosocial risks, this report addresses the impacts on pregnancy and neonatal outcomes of an integrated education and counseling intervention to reduce BPSR, as well as the contributions of other psychosocial and biomedical risks. Subjects were low income AA women ≥18 years living in the Washington, DC, metropolitan area and seeking prenatal care. Subjects (n = 1,044) were screened for active smoking, environmental tobacco smoke exposure (ETSE), depression, or intimate partner violence (IPV) and then randomized to intervention (IG) or usual care (UCG) groups. Data were collected prenatally, at delivery, and postpartum by maternal report and medical record abstraction. Multiple imputation methodology was used to estimate missing variables. Rates of pregnancy outcomes (miscarriage, live birth, perinatal death), preterm labor, Caesarean section, sexually transmitted infection (STI) during pregnancy, preterm birth (<37 weeks), low birth weight (<2,500 g), very low birth weight (<1,500 g), small for gestational age, neonatal intensive care unit (NICU) admission, and >2 days of hospitalization were compared between IG and UCG. Logistic regression models were created to predict outcomes based on biomedical risk factors and the four psychosocial risks (smoking, ETSE, depression, and IPV) targeted by the intervention. Rates of adverse pregnancy and neonatal outcomes were high and did not differ significantly between IG and UCG. In adjusted analysis, STI during the current pregnancy was associated with IPV (OR = 1.41, 95% CI 1.04–1.91). Outcomes such as preterm labor, caesarian section in pregnancy and preterm birth, low birth weight, small for gestational age, NICU admissions and >2 day hospitalization of the infants were associated with biomedical risk factors including preexisting hypertension and diabetes, previous preterm birth (PTB), and late initiation of prenatal care, but they were not significantly associated with active smoking, ETSE, depression, or IPV. Neither the intervention to reduce BPSR nor the psychosocial factors significantly contributed to the pregnancy and neonatal outcomes. This study confirms that biomedical factors significantly contribute to adverse outcomes in low income AA women. Biomedical factors outweighed psychosocial factors in contributing to adverse pregnancy and neonatal outcomes in this high-risk population. Early identification and management of hypertension, diabetes and previous PTB in low income AA women may reduce health disparities in birth outcomes.

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References

  1. MacDorman, M. F., Callaghan, W. M., Mathews, T. J., Hoyert, D. L., & Kochanek, K. D. (2007). Trends in preterm-related infant mortality by race and ethnicity, United States, 1999–2004. International Journal of Health Services, 37(4), 635–641.

    Article  PubMed  Google Scholar 

  2. Paul, D. A., Mackley, A., Locke, R. G., Stefano, J. L., & Kroelinger, C. (2009). State infant mortality: An ecologic study to determine modifiable risks and adjusted infant mortality rates. Maternal Child Health Journal, 13(3), 343–348.

    Article  Google Scholar 

  3. SCHSA. (2002). State center for health statistics administration: Briefing paper on the 2000 infant mortality rate for the district of Columbia.

  4. Mathews, T. J., & MacDorman, M. F. (2008). Infant mortality statistics from the 2005 period linked birth/infant death data set. National Vital Statistics Report, 57(2), 1–32.

    CAS  Google Scholar 

  5. Nothnagle, M., Marchi, K., Egerter, S., & Braveman, P. (2000). Risk factors for late or no prenatal care following Medicaid expansions in California. Maternal Child Health Journal, 4(4), 251–259.

    Article  CAS  Google Scholar 

  6. Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research, 6(Suppl 2), S125–S140.

    Article  Google Scholar 

  7. Leonardi-Bee, J., Smyth, A., Britton, J., & Coleman, T. (2008). Environmental tobacco smoke and fetal health: Systematic review and meta-analysis. Archives of Disease in Childhood. Fetal and Neonatal Edition, 93(5), F351–F361.

    Article  PubMed  CAS  Google Scholar 

  8. Orr, S. T., James, S. A., & Blackmore, P. C. (2002). Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. American Journal of Epidemiology, 156(9), 797–802.

    Article  PubMed  Google Scholar 

  9. Wang, J., & Patten, S. B. (2002). Prospective study of frequent heavy alcohol use and the risk of major depression in the Canadian general population. Depression and Anxiety Journal, 15(1), 42–45.

    Article  Google Scholar 

  10. Chambliss, L. R. (2008). Intimate partner violence and its implication for pregnancy. Clinical Obstetrics and Gynecology, 51(2), 385–397.

    Article  PubMed  Google Scholar 

  11. Sharps, P. W., Laughon, K., & Giangrande, S. K. (2007). Intimate partner violence and the childbearing years: Maternal and infant health consequences. Trauma, Violence & Abuse, 8(2), 105–116.

    Article  Google Scholar 

  12. Silverman, J. G., Decker, M. R., Reed, E., & Raj, A. (2006). Intimate partner violence victimization prior to and during pregnancy among women residing in 26 US. states: Associations with maternal and neonatal health. American Journal of Obstetrics and Gynecology, 195(1), 140–148.

    Article  PubMed  Google Scholar 

  13. Jun, H. J., Rich-Edwards, J. W., Boynton-Jarrett, R., & Wright, R. J. (2008). Intimate partner violence and cigarette smoking: Association between smoking risk and psychological abuse with and without co-occurrence of physical and sexual abuse. American Journal of Public Health, 98(3), 527–535.

    Article  PubMed  Google Scholar 

  14. Alegria, M., Chatterji, P., Wells, K., Cao, Z., Chen, C. N., Takeuchi, D., et al. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Services, 59(11), 1264–1272.

    Article  Google Scholar 

  15. Pomerantz, A., Cole, B. H., Watts, B. V., & Weeks, W. B. (2008). Improving efficiency and access to mental health care: Combining integrated care and advanced access. General Hospital Psychiatry, 30(6), 546–551.

    Article  PubMed  Google Scholar 

  16. Joseph, J. G., El-Mohandes, A. A., Kiely, M., El-Khorazaty, M. N., Gantz, M. G., Johnson, A. A., et al. (2009). Reducing psychosocial and behavioral pregnancy risk factors: Results of a randomized clinical trial among high-risk pregnant African American women. American Journal of Public Health, 99(6), 1053–1061.

    Article  PubMed  Google Scholar 

  17. El-Mohandes, A. A., 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.

    Article  PubMed  Google Scholar 

  18. Thornberry, J. S. (2010). Acceptance, communication mode and use of audio computer-assisted self interview using touchscreen to identify risk factors among pregnant minority women. RTIPRESS-D-09–0016R1, RTI, International. NC: Research Triangle Park.

    Book  Google Scholar 

  19. Melvin, C. L., & Tucker, P. (2000). Measurement and definition for smoking cessation intervention research: The smoke-free families experience. Smoke-free families common evaluation measures for pregnancy and smoking cessation projects working group. Tobacco Control, 9(Suppl 3), III87–III90.

    PubMed  Google Scholar 

  20. Beck, A., Steer, R., & Brown, G. (2000). BDI—FastScreen for medical patients manual. San Antonio, TX: Psychological Corporation, Harcourt Assessment, Inc.

    Google Scholar 

  21. McFarlane, J., Parker, B., Soeken, K., & Bullock, L. (1992). Assessing for abuse during pregnancy. Severity and frequency of injuries and associated entry into prenatal care. JAMA, 267(23), 3176–3178.

    Article  PubMed  CAS  Google Scholar 

  22. El-Khorazaty, M. N., Johnson, A. A., Kiely, M., El-Mohandes, A. A., 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. BMC Public Health, 7, 233.

    Article  PubMed  Google Scholar 

  23. Windsor, R. A. (2000). Counselling smokers in Medicaid maternity care: The SCRIPT project. Tobacco Control, 9(Suppl 1), I62.

    Article  PubMed  Google Scholar 

  24. Hall, S. M., Munoz, R. F., & Reus, V. I. (1994). Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers. Journal of Consulting and Clinical Psychology, 62, 141–146.

    Article  PubMed  CAS  Google Scholar 

  25. Miranda, J., & Munoz, R. (1994). Intervention for minor depression in primary care patients. Psychosomatic Medicine, 56, 136–141.

    PubMed  CAS  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. 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. BMC Pregnancy Childbirth, 8, 22.

    Article  PubMed  Google Scholar 

  28. Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins symptom checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19(1), 1–15.

    Article  PubMed  CAS  Google Scholar 

  29. Lipman, R. S., Covi, L., & Shapiro, A. K. (1979). The Hopkins symptom checklist (HSCL)–factors derived from the HSCL-90. Jouranl of Affective Disorders, 1(1), 9–24.

    Article  CAS  Google Scholar 

  30. Straus, M. (1995). Manual for the conflict tactics scales. Durham, NH: Family Research Laboratory, University of New Hampshire.

    Google Scholar 

  31. Straus, M., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised conflict tactics scale (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283–316.

    Article  Google Scholar 

  32. Raghunathan, T., Solenberger, P., & VanHoewyk, J. (2002). IVEware: imputation and variance estimation software: User guide.

  33. Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H. et al. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics & Gynecology, 110(2 Pt 1), 330–339.

    Google Scholar 

  34. Willis, W. O., Eder, C. H., Lindsay, S. P., Chavez, G., & Shelton, S. T. (2004). Lower rates of low birthweight and preterm births in the California Black Infant Health Program. Journal of the National Medical Association, 96(3), 315–324.

    PubMed  Google Scholar 

  35. Klerman, L. V., Ramey, S. L., Goldenberg, R. L., Marbury, S., Hou, J., & Cliver, S. P. (2001). A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. American Journal of Public Health, 91(1), 105–111.

    Article  PubMed  CAS  Google Scholar 

  36. Savitz, D. A., Dole, N., Terry, J. W., Jr., Zhou, H., & Thorp, J. M., Jr. (2001). Smoking and pregnancy outcome among African-American and white women in central North Carolina. Epidemiology, 12(6), 636–642.

    Article  PubMed  CAS  Google Scholar 

  37. Getahun, D., Nath, C., Ananth, C. V., Chavez, M. R., & Smulian, J. C. (2008). Gestational diabetes in the United States: Temporal trends 1989 through 2004. American Journal of Obstetrics and Gynecology, 198(5), 525 e1–525 e5.

    Article  Google Scholar 

  38. Tanaka, M., Jaamaa, G., Kaiser, M., Hills, E., Soim, A., Zhu, M., et al. (2007). Racial disparity in hypertensive disorders of pregnancy in New York State: A 10-year longitudinal population-based study. American Journal of Public Health, 97(1), 163–170.

    Article  PubMed  Google Scholar 

  39. Goldenberg, R. L., Cliver, S. P., Mulvihill, F. X., Hickey, C. A., Hoffman, H. J., Klerman, L. V., et al. (1996). Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women. American Journal of Obstetrics and Gynecology, 175(5), 1317–1324.

    Article  PubMed  CAS  Google Scholar 

  40. Dew, M. A., Dunn, L. O., Bromet, E. J., & Schulberg, H. C. (1988). Factors affecting help-seeking during depression in a community sample. Journal of Affective Disorders, 14(3), 223–234.

    Article  PubMed  CAS  Google Scholar 

  41. Klinkman, M. S. (1997). Competing demands in psychosocial care: A model for the identification and treatment of depressive disorders in primary care. General Hospital Psychiatry, 19(2), 98–111.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank the field work staff, the interviewers, and the data management staff. Also, we thank the participants, who welcomed us into their lives in hopes of helping themselves and their children. This study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities, National Institutes of Health (3U18HD030445, 3U18HD030447, 5U18HD31206, 3U18HD031919, and 5U18HD036104).

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Authors and Affiliations

  1. Division of Neonatology, Georgetown University Hospital, 3800 Reservoir RD NW, Main 3400, Washington, DC, 20007, USA

    Siva Subramanian

  2. Departments of Pediatrics and Psychiatry, Georgetown University Medical Center, 2115 Wisconsin Ave NW Suite 200, Washington, DC, 20007, USA

    Kathy S. Katz

  3. School of Nursing, George Mason University, 4400 University Dr, MS-3C4, Fairfax, VA, 22030, USA

    Margaret Rodan

  4. RTI-International, 3040 East Cornwallis RD, Research Triangle Park, NC, 27709, USA

    Marie G. Gantz & Nabil M. El-Khorazaty

  5. Department of Nutritional Services, Howard University, 2400 Sixth Street, NW, Washington, DC, 20059, USA

    Allan Johnson

  6. Children’s National Medical Center, Center for Clinical and Community Research, 111 Michigan Avenue, NW, Washington, DC, 20010, USA

    Jill Joseph

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  1. Siva Subramanian
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  2. Kathy S. Katz
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Corresponding author

Correspondence to Siva Subramanian.

Additional information

Nabil M. El-Khorazaty—deceased.

Clinical trials registration number: NCT 00381823.

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Subramanian, S., Katz, K.S., Rodan, M. et al. An Integrated Randomized Intervention to Reduce Behavioral and Psychosocial Risks: Pregnancy and Neonatal Outcomes. Matern Child Health J 16, 545–554 (2012). https://doi.org/10.1007/s10995-011-0875-9

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  • DOI: https://doi.org/10.1007/s10995-011-0875-9

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