1. BEST PRACTICES TO REDUCE LOW BIRTH WEIGHT IN HIGH-RISK POPULATIONS NS 400 UNIVERSITY OF ALASKA ANCHORAGE Kylie Brown, Kayla Williams, Casey Vralsted, Summer Hamrick, and Kelly Paldanius

3. 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).

4. Searchable Question  What are significant interventions for preventing low birth weight newborns in high- risk populations?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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

14. Stakeholders  Maternity nurses & staff  Surgeons  Physicians  Patients & family  Intervention funding sources  Hospital administration

15. 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.

16. 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).

17. 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).

18. 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).

19. 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.

20. 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.

21. Evaluation Plan  Feedback questionnaires from participants.  Audit medical records of LBW newborns and mothers.  Monitor statistics of program participation.  Funding audits every year.

22. 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.

23. 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.

24. 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.