• 11
    Dec
  • LOWER RATES OF LOW BIRTHWEIGHT AND PRETERM BIRTHS: RESULTS Risk

Profiles

Comparison of the risk profiles of women who stayed in BIH and had a singleton birth (n=2031) with those who dropped out of the program (n=l,060, 28% of 3,834 enrolled women) shows that BIH retained the women with the highest risk profiles (Table 1). Table 1 shows that women who remained in the program were more likely to have current health and previous pregnancy problems (p<0.01). Risk for any previous poor pregnancy outcome is between 1.66 (LBW), and 3.00 (previous neonatal death). The risk for PTB is 1.78. Furthermore, the risk for any current health problem for women who remained is between 2.07 (urinary tract infection) and 3.44 (pregnancy-induced hypertension).

Table 1. Comparison of Self-Reported Health Risks of Clients Who Remained in BIH with Clients Who Dropped Out of BIH

Remained Dropped out
in BIH of BIH b

OR

F

>
Any Previous Poor Pregnancy Outcome

14.3

8.3

1.72

<0.

.01
Previous low birthweight

6.8

4.1

1.66

<0.

.05
Previous preterm delivery

8.0

4.5

1.78

<0.

.01
Previous intrauterine tetal demise

1.5

0.6

2.50

<0.

.01
Previous neonatal death

1.5

0.5

3.00

<0,

.01
Previous Spontaneous Abortion

25.0

14.2

1.76

<0,

.01
Any Current Health Problem

27.1

11.5

2.36

<0.

.01
Anemia

15.4

6.6

2.33

<0,

.01
Urinary tract infection

6.0

2.9

2.07

<0,

.01
Preterm labor

4.7

2.1

2.24

<0.

.01
Gestational diabetes

2.6

0.9

2.89

<0.

.01
Pregnancy induced hypertension

3.1

0.9

3.44

<0,

.01

Table 2 presents data on the self-reported previous pregnancy and current health risks for all BIH Program women who had a singleton birth during the study period (total BIH), and for selected BIH sites. Focusing on total BIH, the data shows that the highest prevalence of previous poor pregnancy outcomes are PTB (8.0%) and LBW (6.8%). One in four women (25%) reported a previous spontaneous abortion. Somewhat more than one in four women (27.1%) reported a current health problem. Specific current health problems were anemia (15.4%), urinary tract infection (6.0%), and preterm labor (4.7%). The data for the selected sites will be presented later in the paper. eriacta 100 mg

Table 2. BIH Clients Self-Reported Previous Pregnancy and Current Health Risk Factors (Percent)

BIH

Selected BIH sites

Total3 A В С D
Any Previous Poor Pregnancy Outcome

14.3

14.3

20.7

7.5

7.1

Previous low birthweight

6.8

11.7

6.9

1.3

5.4

Previous preterm delivery

8.0

5.2

10.3

1.3

3.6

Previous intrauterine fetal demise

1.5

0.0

1.1

2.5

0.0

Previous neonatal death

1.5

2.6

2.3

2.5

0.0

Previous Spontaneous Abortion

25.0

26.0

28.7

30.0

16.1

Any Current Health Problem

27.1

18.2

13.8

52.5

25.0

Anemia

15.4

5.2

5.7

42.5

16.1

Urinary tract infection

6.0

6.5

2.3

16.3

8.9

Preterm labor

4.7

6.5

3.4

2.5

5.4

Gestational diabetes

2.6

0.0

0.0

1.3

3.6

Pregnancy induced hypertension

3.1

0.0

2.3

7.5

1.8

Psychosocial risks for total BIH participants and for selected sites are presented in Table 3. It shows that among total BIH women, there is a particularly high prevalence of concern about resources. This includes worries about making ends meet (78.4%), a decrease in income in the last 12 months (55.2%), and no financial support from a partner (53.7%). Other significant risk factors were having moved in last 12 months (61.3%), and having a partner who is now or has been in jail (50.1%). Similar proportions of women were uncomfortable with their living arrangements (37.8%) or had someone close who had drug or alcohol problems (40%). Nearly 30% had a friend die in the last 12 months. The prevalence of these risk factors in the comparison population is not known. (The psychosocial risk factors for the selected sites are discussed later.) suhagra 100

Table 3. BIH Clients Self-Reported Psychosocial Risk Factors (Percent)

BIH Total3 Selected BIH Sites ABC D
Worries about making ends meet 78.4 75.4 80 86.7 81.7
Income has decreased within 12 months 55.2 45.8 60.9 68.4 53.4
Partner not available for financial support 53.7 46.4 44.3 51.5 57.3
Moved within last 12 months 61.3 43.7 60.0 72.2 64.4
Not comfortable w/living arrangements 37.8 42.3 42.6 39.8 37.8
Partner is now or has been in jail 50.1 48.6 68.4 54.1 50.0
Someone close w/alcohol or drugs problems within the last 12 months 40.0 31.8 47.0 39.4 44.4
Close friend died within the last 12 months 27.2 23.9 27.8 25.0 30.7

Though 75% of BIH women reported not having smoked during the current pregnancy, 20% of the participants smoked for some part of the pregnancy. Eighty-four percent reported no alcohol use, and 80% reported no drug use in pregnancy. Data on these behavioral risk factors for the comparison population were not available. However, MacDor-man reports that smoking during pregnancy has declined overall nationwide by 37% since 1989, with a rate for black women of 9.1% in 2000.

Lastly, demographic and past pregnancy histories for BIH, Medi-Cal comparison group, and all Californian African-American women were compared. The BIH population has fewer high-school graduates (32.8%, 50%, and 51%, respectively); more single women (80.9%, 77% and 59%, respectively), and significantly more previous LBW (7%, 2%, and 2%, respectively); and PTBs (8%, 2%, and 2%, respectively).

Prenatal Care

BIH participation and prenatal care are not synonymous but complementary services.

Of the BIH women who had a singleton live birth (n=2,031), 60.8% began prenatal care in the first trimester, 27.6% in the second trimester, and 11.6% in the third trimester. Five-hundred-twenty-eight women enrolled in BIH without prenatal care, and 444 (84%) of them were assisted with initiation and maintenance of prenatal care. Among the Medi-Cal comparison group, 75.8% initiated prenatal care in the first trimester, 20.7% in the second, and 3.5% in the third trimester. BW and PTB outcome comparisons were made between women who entered BIH before 32 weeks’ gestation, and the Medi-Cal comparison group. Birthweight outcomes are presented in Table 4 (n= 1,545, eight missing). Birthweight was analyzed in three categories: <2,500 g, 1,500-2,499 g, and < 1,500 g. Total LBW (<2,500 g) among BIH clients was higher than that of the comparison women. It was 14.9% for BIH neonates and 14.1% for the comparison group. The estimated risk for BIH to comparison group is 1.07 (CI 0.83-1.38, p=0.61). Thirteen percent of BIH neonates were in the 1,500-2,499-g BW category, and 11% of the comparison neonates. This estimated risk for BIH to comparison group is 1.21 (CI 0.91-1.6, p=0.17). The rate of VLBW (< 1,500 g) among neonates born to women in BIH was 1.9% as compared to 3.0% among comparison women. The BIH to comparison estimated risk is 0.63 (CI .34-1.16, p=0.11).

Table 4. Birth weight Outcomes in BIH Program Newborns and Medi-Cal Comparison Group Newborns

Birthweight Categories

BIH1

July 1996-Sept. 1998 (N=1,545)3

ComparisonGroup2 (N=11,633) OR

95% CI

P

< 1,500 grams

1.9%

3.0% 0.63 0.34-1.16

0.11

1,500-2,499 grams

13.0%

11.0% 1.21 0.91-1.60

0.17

<2,500 grams

14.9%

14.1% 1.07 0.83-1.38

0.61

PTB outcomes (n= 1,553) are shown in Table 5. The total PTB rate (<37 weeks) for BIH neonates was 17.9%), which was the same as the comparison group (17.9%). BIH had a slightly higher proportion (14.4%) of moderately PTBs (32-37 weeks) than the comparison group (13.6%). The estimated risk for BIH to comparison is 1.07 (CI 0.82-1.39, p=0.61). At less than 32 weeks’ gestation, the rate of BIH PTBs was 3.5%—less than that for the comparison births (4.3%). The estimated risk for BIH very preterm to the comparison group is 0.81 (CI 0.50-1.3,p=0.36).
buy antibiotics canada

Figure 1. Total Low Birthweight

Figure 1. Total Low Birthweight in BIH and the Comparison Group Contrasted with the Year-2000 Health Objectives

Finally, to analyze BIH outcomes in relation to goals set forth by the Healthy People 2000 Objectives for the Nation, comparisons were made between the outcomes in BIH and the Healthy People 2000 LBW objective (Figure 1). Figure 1 data compares LBW in BIH and the Medi-Cal comparison group to the 2000 goal. Total LBW for both groups did not meet the 2000 goal. Figure 1 also compares LBW in four selected BIH sites and in the corresponding Medi-Cal comparison ZIP codes. The selected BIH project sites are presented, because they achieved LBW rates well below the year-2000 goal of 9.0%. The LBW rate in Site A was 3.4%o, which is 62% lower than the 2000 objective. The LBW rate in Site В was 4.9%, which is 46% lower, while the 5.6% in Site C, and 7.8% in Site D are 38%) and 13% lower, respectively, than the Healthy People 2000 objective. Furthermore, each of the BIH selected sites is between 28% and 55% less than the corresponding comparison ZIP codes.
cheap generic viagra

Table 5. Preterm Birth Outcomes in BIH Program Newborns and Medi-Cal Comparison Group Newborns

Preterm Delivery

BIH1

Comparison

95%

Categories

July 1996-Sept. 1998

Group2

OR

CI

P

(N=1,553)

(N=11,633)

<32 weeks

3.5%

4.3% 0.81 0.50-1.30 0.36
32-37 weeks

14.4%

13.6% 1.07 0.82-1.39 0.61
<37 weeks

17.9%

17.9% 1.0

In order to determine whether the selected sites have differential risk factors from the BIH population overall, which could account for the favorable results, the data in Tables 2 and 3 is reviewed again here. Table 2 stratifies the self-reported health risk factors for these four sites so that they can be compared to the total BIH population. Though previous pregnancy and current pregnancy risk factors vary somewhat across the selected sites, the distribution of these factors appears to be random. Finally, an examination of Table 3 for differences in the psychosocial risk factors for the selected BIH sites, compared to the total BIH population, does not reveal any psychosocial factor differences which may have given an outcomes advantage to the selected sites.

Online Pharmacy