Project DC-HOPE of The NIH-DC Initiative to

Reduce Infant Mortality in Minority Populations

Ayman El-Mohandes, MBBCh, MD, MPHProfessor and Chairman Department of Prevention and Community Health

sphaxe@gwumc.edu (202) 416-0415

Background

Elevated infant mortality in African American13.6 (AA) versus 3/1000 (C) live births in DC 2003

Medical risks not fully explanatory

Behavioral/psychosocial factors may affect pregnancy outcomes

Little intervention research to date

Study ObjectiveTo evaluate the efficacy of an

integrated counseling/intervention on selected behavioral/psychosocial risks in

pregnancy and the postpartum (PP) period.

Smoking Passive smoking (ETS exposure) Depression Intimate partner violence (IPV)

Population

Eligible ParticipantsAfrican-American at least 18 years of agereceiving PNC at one of the 6 participating

clinics between 7/9/2001 and 10/31/2003 Enrolled by 28 weeks gestationEnglish speaking

Project DC-HOPE:

Screening Methods Audio-Computer Assisted Self

Interviewing

- Mothers were screened for smoking, depression, ETSE and IPV

Behavior/psychosocial Characteristics (N=1044)

Active Smoking

48%* 

Passive Smoking 44%*

* 412 women with both active and passive smoking in the active smoking group. 88 women with active but not passive smoking.

n=270 n=297

n=10

n=116

n=64 n=16

n=50

IPV 21%

Depression 36%

 

n=86

n=59

n=44

n=32

Study Group at Screening (N=1044)

N Risk

Behaviors% Cumulativ

e %

1 40.4 40.2

2 37.0 77.4

3 17.0 94.4

4 5.6 100.0

Conclusions

Psycho-behavioral integrated interventions during pregnancy are effective in modifying risk during pregnancy and in the post-partum period.

Modifying effects are important and unique to various risks and should be addressed in order to maximize benefit.

Logistic Regression for at Least One Risk Resolution

Parameters

Category P-Value Odds Ratio

95% CI for OR

Women resolved at least one risk vs. women resolved no risks at postpartum

Care Group

I vs. UC 0.003 1.65 1.19-2.28

Illicit Drugs

Y vs. N 0.01 0.54 0.33-0.86

ETSE Y vs. N 0.0001 3.79 2.48-5.78

Depression

Y vs. N 0.0001 3.43 2.47-4.76

IPV Y vs. N 0.0001 4.07 2.95-5.60

Does the Intervention Affect Medical Outcomes?

Pregnancy Outcomes (Smoking)

Intervention Usual Care P-value

Miscarriage 1.4% 4.8% 0.04

Preterm <37 wk 12.2% 13.3% 0.73

V. Preterm <33 wk 1.0% 4.6% 0.03

E. Preterm <28 wk 0% 2.1% 0.04

LBW <2500 gm 13.3% 10.8% 0.45

VLBW <1500 gm 0.5% 2.7% 0.08