• 10
    Dec
  • LOWER RATES OF LOW BIRTHWEIGHT AND PRETERM BIRTHS: METHODS

A prospective observational study design with a comparison group was used. BIH participants with a delivery recorded between July 1996 and September 1998 and who had entered the BIH Program prior to 32 weeks’ gestation, were included in the birthweight (BW) and PTB analyses. These outcomes for BIH participants (n=l,553) were compared to those of all African-American women in the BIH Program’s targeted ZIP codes (n=l 1,633). Some descriptive data on the entire BIH population was analyzed in order to provide a context for the study.

Data Sources

The two sources of data for the BIH participants were the BIH computerized management information system, and a psychosocial and life events screening tool. The African-American-specific psychosocial and life events screening tool was designed for and pilot tested on African-American pregnant women. It was used before program enrollment to determine each BIH participant’s risk profile. kamagra uk

The computerized data system was developed in FoxPro 6.0 The system reflects an overarching value for the importance of data to document intervention model exposure and outcomes after participation. The system captured BIH participants’ demographics, health and reproductive histories, as well as tracked their use of BIH services and other prenatal and postdelivery services. Infant data allowed tracking up to 24 months of age. Information on fathers/male partners and support systems was also collected. Local jurisdiction (site) staff was trained to carry out data collection and entry. System managers in each site handled quality control and produced reports essential to local project operations. Medi-Cal claims data and California birth cer­ tificate data for 1997 (the most recent and complete birth files at the time of the study) were the data sources for comparison women.

Study Population

In 1997, 6.9% of the 525,455 women who delivered in California were African-American. During the study period—July 1, 1996 and September 30, 1998—3,834 women were enrolled in the BIH Program, which represented 2.6% of all African-American deliveries in the state. Among the enrolled women, 2,132 had a pregnancy outcome recorded (56%), 2,031 of them had singleton live births. Eleven percent of the BIH women were still pregnant, 4% entered the program postpartum, 28% had dropped out, and 1% were missing.
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The comparison group was 11,633 African-American women on Medi-Cal (California Medicaid) who delivered in 1997 in the same ZIP codes where BIH projects were located. BIH and comparison women were matched on the selection criteria of race, geographic area, and insurance.

Data Analysis

SAS 8.0 and SPSS 1 1.5 software was used for the analysis. Data were presented on the BIH population demographics and risk profiles, and on program and prenatal care participation. Next, demographic and risk profiles for BIH and the comparison group were examined for similarities and differences. Finally, the data was analyzed for differences between the two groups across BW and PTB categories. LBW categories for analysis were <2,500 g (total LBW), 1,500-2,499 g (moderate LBW), and <1,500 g (very LBW-VLBW). PTB categories for analysis were <37 weeks (total PTBs), 32-37 weeks (moderate preterm), and <32 weeks (very preterm). Confidence limits (95%) on the proportions were calculated.
BIH women included in the analyses of PTB and LBW outcomes had entered the BIH Program before 32 weeks of pregnancy (N=1553). This criterion was imposed to avoid bias related to interpretation of program effect caused by the inclusion of women entering the program at 32 or more weeks of gestation. Women who started the BIH Program at 32 or more weeks would bias program results toward larger babies. In addition, pregnancies among these women had already survived a significant amount of the time during which early birth could have occurred.

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