title: Very preterm birth is reduced in women receiving an integrated behavioral intervention: a randomized controlled trial.
abstract: 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.
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4355, USA. aelmohandes@unmc.edu
authors.forename: Ayman A E
authors.initials: AA
authors.lastname: El-Mohandes
authors.forename: Michele
authors.initials: M
authors.lastname: Kiely
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.forename: M Nabil
authors.initials: MN
authors.lastname: El-Khorazaty
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D001521:Behavior Therapy; D003863:Depression / Q000517:prevention & control / Q000523:psychology; D004219:District of Columbia; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000208:ethnology* / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000523:psychology; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000517:prevention & control; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014505:Urban Population; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution