179538 Do smoking and depression during pregnancy impact risk resolution in women receiving an integrated behavioral intervention?

Tuesday, October 28, 2008

Michele Kiely, DrPH , Division of Epidemiology, Statistics & Prevention Research, National Institute of Child Health and Human Development/NIH, Rockville, MD
M. Nabil El-Khorazaty, PhD , Statistics and Epidemiology Unit, RTI International, Rockville, MD
Ayman El-Mohandes, MD, MBBCh, MPH , College of Public Health, University of Nebraska Medical Center, Omaha, NE
Smoking and depression may impact pregnancy outcomes and resolution of these risks should contribute to healthy mothers and infants.

The objective is to assess the efficacy of an integrated behavioral intervention on the resolution of smoking and depression risks at delivery.

An RCT was implemented in Washington, DC. Pregnant women were screened for smoking, depression, environmental tobacco smoke exposure, and intimate partner violence. 1,044 African American women were randomized to the intervention (IG) or usual care (UCG) groups. IG women received educational/counseling. Women were interviewed prior to delivery to assess risk resolution.

For women smoking at baseline, 28.7% resolved this risk at delivery, while for women depressed at baseline, 34.6% resolved this risk. Resolution rates were 32.8% and 36.1% for IG, and 24.1% and 33.3% for UCG, respectively. Risk resolution depended on the combination of risks. For non-depressed smokers, 31.3% IG resolved smoking vs. 16.7% for UCG. For depressed non-smokers, 42.7% IG resolved depression vs. 36.8% for UCG. For depressed smokers, 34.4% IG resolved smoking vs. 29.4% for UCG. Depression resolution was significantly higher among non-smokers vs. smokers (42.7% vs. 25.0%, p<.10). Smoking resolution was not affected by whether women were depressed or not, implying that they were heavy smokers, addicted to smoking regardless of depression; a result confirmed by multivariate analyses.

Women did not respond uniformly to the intervention. Presence of both smoking and depression was an impediment to resolving these risks by delivery, especially with respect to depression. An intensive intervention is recommended for heavy smokers.

Learning Objectives:
1. Understand the efficacy of an integrated behavioral intervention on the resolution of smoking and depression risks at delivery 2. Primary care providers should screen carefully for both smoking and depression among pregnant women.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was involved in the implentation and analysis of the study as well as I wrote the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Maternal, Infant, Child and Family Health Poster Session
See more of: Epidemiology