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

1. best practices to reduce low birth weight in high-risk populationsNS 400University of Alaska Anchorage Kylie Brown, Kayla Williams, Casey Vralsted, Summer Hamrick, and Kelly Paldanius

3. 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).

4. Searchable Question • What are significant interventions for preventing low birth weight newborns in high-risk populations?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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

14. Stakeholders • Maternity nurses & staff • Surgeons • Physicians • Patients & family • Intervention funding sources • Hospital administration

15. 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.

16. 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 Visitation • Bi-weekly visitation reduced prevalence through providing psychosocial support and community services (Lee et al, 2009 – Level II).

17. 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).

18. 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-Mohandeset al, 2011 – Level II).

19. 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.

20. 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.

21. Evaluation Plan • Feedback questionnaires from participants. • Audit medical records of LBW newborns and mothers. • Monitor statistics of program participation. • Funding audits every year.

22. 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.

23. 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.

24. 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 hispanicwomen. Journal of Midwifery & Women’s Health, 57(5), 476-481. • WillemsVan 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.