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.
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.
Level of evidence I.
- Content Type Journal Article
- Pages 1-10
- DOI 10.1007/s10995-011-0875-9
- Authors
- Siva Subramanian, Division of Neonatology, Georgetown University Hospital, 3800 Reservoir RD NW, Main 3400, Washington, DC 20007, USA
- Kathy S. Katz, Departments of Pediatrics and Psychiatry, Georgetown University Medical Center, 2115 Wisconsin Ave NW Suite 200, Washington, DC 20007, USA
- Margaret Rodan, School of Nursing, George Mason University, 4400 University Dr, MS-3C4, Fairfax, VA 22030, USA
- Marie G. Gantz, RTI-International, 3040 East Cornwallis RD, Research Triangle Park, NC 27709, USA
- Nabil M. El-Khorazaty, RTI-International, 3040 East Cornwallis RD, Research Triangle Park, NC 27709, USA
- Allan Johnson, Department of Nutritional Services, Howard University, 2400 Sixth Street, NW, Washington, DC 20059, USA
- Jill Joseph, Children’s National Medical Center, Center for Clinical and Community Research, 111 Michigan Avenue, NW, Washington, DC 20010, USA
- Journal Maternal and Child Health Journal
- Online ISSN 1573-6628
- Print ISSN 1092-7875