Understanding the Association of Biomedical, Psychosocial and Behavioral Risks with Adverse Pregnancy Outcomes Among African-Americans in Washington, DC

This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington,
DC and sociodemographic risk factors, behavioral risk factors, and the most common and interrelated medical conditions occurring
during pregnancy: diabetes, hypertension, preeclampsia, and Body Mass Index (BMI). Data are from a randomized controlled trial
conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental
tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed
and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: (1) explore the
relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes;
(2) identify the relative importance of various predictors of adverse pregnancy outcomes; and (3) characterize women at the
highest risk of poor pregnancy outcomes. The strongest predictors of poor outcomes were prepregnancy BMI, preconceptional
diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter
for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission;
BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; employment was the
first splitter for miscarriage. Preconceptional factors strongly influence pregnancy outcomes. For many of these women, the
high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy.