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