Reducing psychosocial and behavioral pregnancy risk factors: results of a randomized clinical trial among high-risk pregnant african american women.
OBJECTIVE
We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes (cigarette smoking, secondhand smoke exposure, depression, and intimate partner violence).


METHODS
Pregnant African American women (N = 1044) were randomized to an intervention or usual care group. Clinic-based, individually tailored counseling sessions were adapted from evidence-based interventions. Follow-up data were obtained for 850 women. Multiple imputation methodology was used to estimate missing data. Outcome measures were number of risks at baseline, first follow-up, and second follow-up and within-person changes in risk from baseline to the second follow-up.


RESULTS
Number of risks did not differ between the intervention and usual care groups at baseline, the second trimester, or the third trimester. Women in the intervention group more frequently resolved some or all of their risks than did women in the usual care group (odds ratio = 1.61; 95% confidence interval = 1.08, 2.39; P = .021).


CONCLUSIONS
In comparison with usual care, a clinic-based behavioral intervention significantly reduced psychosocial and behavioral pregnancy risk factors among high-risk African American women receiving prenatal care.
Children's Research Institute, Children's National Medical Center, Washington, DC, USA.
Jill G
JG
Joseph
Ayman A E
AA
El-Mohandes
Michele
M
Kiely
M Nabil
MN
El-Khorazaty
Marie G
MG
Gantz
Allan A
AA
Johnson
Kathy S
KS
Katz
Susan M
SM
Blake
Maryann W
MW
Rossi
Siva
S
Subramanian
D001741:Black or African American / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods; D003866:Depressive Disorder / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D011247:Pregnancy / Q000208:ethnology* / Q000523:psychology*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods; D012044:Regression Analysis; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D013179:Spouse Abuse / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
D014028:Tobacco Smoke Pollution