LOWER RATES OF LOW BIRTHWEIGHT AND PRETERM BIRTHS
The toll of infant morbidity and mortality associated with low birthweight (LBW) and preterm birth (PTB) has been investigated in numerous studies over the last 40 years. Associated factors, such as demographics, pregnancy history, personal behaviors, and access to prenatal care, are addressed repeatedly in the literature. However, there is still a less-than-adequate understanding of the biologic and social factors underlying their association with neonatal outcomes.
Associations between neonatal outcomes and race are by far the least understood. Furthermore, because race is so intertwined with economic and social status, and lifestyle and culture, as well as access to social and health services, it is difficult to determine its real meaning in relation to poor neonatal outcomes. It is probable that race is a marker for other potentially modifiable population-based factors. An understanding of population characteristics, culture, values, and experiences enriches the science of health interventions.
Interventions that apply both science and knowledge about the population to be engaged in the intervention are more likely to advance understanding of the relationship between social and healthcare systems, individual behavior, and health outcomes. An intervention of this type is the California Black Infant Health (BIH) Program that uses the public health sciences of epidemiology, and health behavioral change interventions, as well as community-based and culture-based practice methodologies.
The objective of this study is to determine the impact of prenatal interventions in the California BIH Program on LBW and PTB outcomes.
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Similar intervention studies have yielded mixed findings. Korenbrot et al. studied the outcomes of women of the OB Access Projects and the Comprehensive Perinatal Services Program in California. Participants in these programs had LBW and very-low-birthweight (VLBW) rates that were significantly less than those of women in care with routine Medicaid providers. Zimmer-Gembeck found that psychosocial services intervention was related to a reduced rate of LBW. Beuscher evaluated publicly funded prenatal care in North Carolina and found that Medicaid women who received this service had substantially lower rates of LBW, VLBW, and infant mortality.
From 1986-1989, the Better Babies Project in the District of Columbia was the first community-based targeted intervention designed specifically for the purpose of reducing African-American infant LBW. Though the project evaluation did not show an overall program impact on LBW, program participants did have a lower rate of LBW than nonparticipants. pharmacy united kingdom
Randomized clinical trials methodology has been used in some of the latest research on the impact of prenatal interventions. The effect of a telephone call intervention on LBW was studied by Moore et al. They found statistically significant differences between intervention and control groups for black women only who were 19 years of age and older. A social support intervention designed specifically to be culturally relevant for African-American women was conducted by Nor-beck. LBW was found to be 60% less in the intervention group than in the control group.
Klerman studied the effect of an augmented prenatal care intervention on Medicaid eligible African-American women. This randomized trial found no statistically significant differences in LBW and PTB outcomes between the intervention and comparison groups.