Background and Significance Low birth weight newborns: chance of early mortality, health problems, and developmental delays (Lee, et al. 2009). 2x more likely to be in foster care and maltreated (Lee, et al. 2009). by 19% in the United States (Hamilton, Martin & Ventura, 2010). Strongly coincide with low SES & racial/ethnic disparities (Reichman, Hamilton, Hummer and Padilla, 2007).
Searchable Question What are significant interventions for preventing low birth weight newborns in high- risk populations?
Assessing the effectiveness of the health start program in Arizona (Hussaini, Holley, & Ritenour, 2011). Quasi-experimental study, Level III Nonprobability quota sample 5,480 pregnant females Health Start Program Babies born to mothers in HSP have better birth weight outcomes compared to those who are not Strengths Greater external validity Feasible time Weaknesses Possible bias from HSP participants More rigorous evaluation
Factors predicting birth weight in a low-risk sample: The role of modifiable pregnancy health behaviors. (Bailey, & Byrom, 2007). Quasi-experimental study, Level III Nonprobability quota sample 220 pregnant females Doctor-patient communication, patient centered care Pregnancy smoking was the strongest behavioral predictor of LBW Strengths Medical charts thorough & complete Conducted by one researcher w/supervision Weaknesses Overrepresentation of women receiving Medicaid Self-reporting of smoking
Reducing low birth weight through home visitation. (Lee et al., 2009). RCT, Level II Simple random group sample 501 pregnant women Bi-weekly home visitation services Services reduced prevalence of LBW to 5% Strengths: RCT Large sample, intervention fidelity Weakness: Study part of larger trial
The impact of prenatal coordination on birth outcomes. (Willems Van Dijk et al., 2010). Cross-sectional/Secondary Analysis, Level IV 45,406 pregnant women Receiving Medicaid Compared newborns born to women w/Medicaid & PNCC services vs. infants born to women w/Medicaid & no PNCC services PNCC risk of having a LBW baby by 16% Strengths: Large sample size Cost-effective Convenience of preexisting data Weaknesses: Lacks full randomization Limited generalizability
Birth outcomes associated with receipt of group prenatal care among low-income Hispanic women. (Tandon et al., 2012). Experimental study, Level II Self-selection sample 294 Pregnant Hispanic women Centering Pregnancy vs. Traditional prenatal care Comparison of birth outcomes made by abstraction of medical records LBW: 7% traditional vs. 5% group not statistically significant Strengths: Used well-established research instruments Excellent follow-up data collection rates Weaknesses: Care given by NP’s Small sample size Lacks randomization
Perinatal depression and birth outcomes in a healthy start project. (Smith et al., 2010). Quasi-Experimental study, Level III Nonprobability quota sample 1,100 Pregnant women Questionnaire administered Enrollment vs. Non-enrollment of Healthy Start Initiative (HSI) Enrollment in HSI showed little statistical significance to the occurrence of LBW newborns. Strengths: Strict criteria & eligibility Large sample size Feasible Weaknesses: Lacks randomization Lacked clarity
Support during pregnancy for women at increased risk of low birth weight babies. ( Hodnett, Fredricks, & Weston, 2010). RCT, Level I Randomized sample 12,264 women Provided addition support programs for those at risk Support helped w/ antenatal hospital admission & C-sections, it showed little significance in reducing LBW Strengths: High-level Cochrane review Evaluated other studies using the Cochrane search strategy RTC Weakness: Missing details & incomplete data from several trials.
Very preterm birth is reduced in women receiving an integrated behavioral intervention: A randomized controlled trial. (El-Mohandes, Kiely, Gantz, & El-Khorazaty, 2010). RCT, Level II Randomized, strict eligibility criteria 1,044 women Integrated behavioral interventions reducing psycho-behavioral risks Smoking, depression, intimate partner violence Strengths RCT Strict eligibility criteria Audio-computer for self interview Weakness Expensive Not meant to test efficacy of intervention w/ pregnancy outcomes but resolution of psycho-behavioral risks Inability to reach 9.7% of women in intervention group
Reducing low birth weight by resolving risks: Results from Colorado's prenatal plus program. (Ricketts, Murray, & Schwalberg, 2005). Quasi-Experimental study, Level III Convenience Sample/Existing Data 3569 Medicaid eligible women Prenatal Plus Program Interventions impact on specific risk factors for LBW Interventions were successful in LBW Strengths Large sample Data already collected Cost effective, feasible External validity Weakness Self report of risk factors/resolution Attrition from program Access of services through Medicaid/private payers
Future Research Adequate follow up on studies performed. RCT’s to selection bias and generalizability. Studies to include a wider range of participants consistent for different ethnic & cultural backgrounds. Cost effective analysis to establish economic biases. Follow-up correlation studies between smoking cessation & the rate of LBW newborns.
Summary of Evidence Prenatal Programs Health Start Provides prenatal care, family education, support, referrals, and advocacy services. (Hussaini, Holley, & Ritenour, 2011- Level III). Healthy Families New York Home Visitation Bi-weekly visitation reduced prevalence through providing psychosocial support and community services (Lee et al, 2009 – Level II).
Summary of Evidence Government Funded Programs Prenatal Care Coordination Provides pregnancy risk assessments, mutually agreed upon care plan, ongoing care coordination, and education services. (Willems Van Dijk, Anderko, & Stetzer, 2010 – Level II). Prenatal Plus Provided 10 visits based upon risk factors including two off site or home visits (Ricketts, Murray, & Schwalberg, 2005 – Level III).
Summary of Evidence Behavioral modifications Smoking Strongest predictor and modifier of LBW (Bailey & Byrom, 2007 – Level III). IPV Information on types of abuse, cycle of violence, danger assessment and safety plan (El- Mohandes et al, 2011 – Level II).
Results Critical appraisal of the literature indicates that the number of LBW newborns with proper prenatal interventions will be significantly reduced in high-risk populations.
Plan of Implementation Promote use & importance of prenatal services. Provide: Smoking cessation programs for expectant mothers. Resources for IPV counseling & therapy. Ensure proper funding to expand & continue programs. Encourage well child check ups & annual gynecological exams.
Evaluation Plan Feedback questionnaires from participants. Audit medical records of LBW newborns and mothers. Monitor statistics of program participation. Funding audits every year.
Conclusions Prenatal Programs were statistically significant to reduce LBW newborns in high-risk populations. Smoking cessation is directly associated with a in LBW newborns. Promotion of prenatal and continuous services have a effect on birth outcomes.
References Bailey, B., & Byrom, A., (2007). Factors predicting birth weight in a low-risk sample: The role of modifiable pregnancy health behaviors. Maternal Child Health, 11(2), 173-179. El-Mohandes, A. A., Kiely, M., Gantz, M. G., & El-Khorazaty, N. M. (2010). Very preterm birth is reduced in women receiving an integrated behavioral intervention: A randomized controlled trial. Maternal & Child Health Journal, 15(1), 19-28. Hamilton, E. B., Martin, A. J., & Ventura, J. S., (2010). Births: Preliminary data for 2008. National Vital Statistics Reports, 58(16), 1-17. Hodnett, E.,D., Fredericks, S., & Weston, J. Support during pregnancy for women at increased risk of low birth weight babies. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD000198. Hussaini, S., Holley, P., & Ritenour, D. (2011). Reducing low birth weight infancy: Assessing the effectiveness of the health start program in arizona. Maternal and Child Health, 15(2), 225-33. Lee, E., Mitchell-Herzfeld, S. D., Lowenfels, A. A., Greene, R., Dorabawila, V., & DuMont, K. A. (2009). Reducing low birth weight through home visitation: A randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154-160.
References Ricketts, S. A., Murray, E. K., & Schwalberg, R. (2005). Reducing low birthweight by resolving risks: Results from colorado's prenatal plus program. American Journal of Public Health, 95(11), 1952-1957. Smith, V. M., Shao, L., Howell, H., Lin, H., &Yonkers, A.K. (2007). Perinatal depression and birth outcomes in a healthy start project. Matern Child Health, 1(15), 401-409. Tandon, S.D., Colon, L., Vega, P., Murphy J. & Alonso, A. (2012). Birth outcomes associated with receipt of group prenatal care among low-income hispanic women. Journal of Midwifery & Women’s Health, 57(5), 476-481. Willems Van Dijk, J.A., Anderko, L., & Stretzer, F. (2010). The impact of prenatal care coordination on birth outcomes. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 1(40), 98-108.