BEST PRACTICES TO REDUCE LOW BIRTH WEIGHT IN

HIGH-RISK POPULATIONS

NS 400UNIVERSITY OF ALASKA ANCHORAGE

Kylie Brown, Kayla Williams, Casey Vralsted, Summer Hamrick, and Kelly Paldanius

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

Stakeholders

Maternity nurses & staffSurgeonsPhysiciansPatients & familyIntervention funding

sourcesHospital administration

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 VisitationBi-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.