Very Premature Birth Rates Reduced in an Integrated Behavioral Intervention Targeting High Risk Pregnancy in African American Residents of the District of Columbia

Prematurity is a recognized measurable outcome for high risk pregnancy and a predictor of infant death. The gestation of <37 weeks although agreed upon as the international standard is currently not associated with increased risk for neonatal mortality in industrialized countries. Recent literature suggests being very premature (VPM), defined as <34 weeks gestation, to be more predictive of morbidity and mortality.

In this randomized clinical trial 1,044 African American residents of the District of Columbia participated in an integrated behavioral intervention targeting active smoking, environmental tobacco smoke exposure, depression and intimate partner violence (IPV) in pregnancy. The intervention consisted of counseling/behavioral modification sessions for risks reported at baseline. The differences in rates of prematurity among singleton births in intervention (IG) and usual care groups (UCG) were compared. The prematurity rate (11.9%) in IG was not significantly different from UCG (13.0%, p=0.653). The rate for VPM (2.2%) in the IG was significantly lower than UCG (5.1%, p=0.033) in bi-variate analyses. In a reduced logistic model accounting for the other significant variables associated with VPM (IPV) the effect of the intervention retained significance at OR=0.42, 95% C.I.:0.189-0.933. IPV at baseline also influenced VPM rates significantly OR=2.938, 95% C.I.:1.401-6.162.

In our study it appears that measuring prematurity <37 weeks as the only pregnancy outcome in a population expressing significant psycho-behavioral risk would have masked the significant risk reduction effect of our integrated intervention. We recommend the adoption of measuring VPM rates in clinical interventions even when prematurity does not appear to be affected.