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Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness

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Abstract

Objective We evaluate the impact of the Healthy Start intervention program on feto-infant morbidity within a community setting. Methods Prospective data from 2002 to 2007 within the ongoing Federally funded Healthy Start intervention project in Central Hillsborough County were merged with corresponding birth outcomes data from the Florida Department of Health. The impact of the project on the following feto-infant morbidity indices was assessed among service recipients: low birth weight (LBW), very low birth weight (VLBW), preterm, very preterm, small for gestational age (SGA) and a composite feto-infant morbidity outcome. Program effectiveness and impact were measured using odds ratios from logistic regression models and number needed to treat (NNT). Results The risk for low birth weight (OR = 0.7; 95% CI = 0.5–1.0), preterm (OR = 0.7; 95% CI = 0.5–0.9) and the composite feto-infant morbidity outcome (OR = 0.8; 95% CI = 0.6–0.9) was reduced among service recipients (N = 536) as compared to non-recipients (N = 2,815). A clinically important level of risk reduction was also noted for very low birth weight (OR = 0.5; 95% CI = 0.2–1.1) and very preterm (OR = 0.6; 95% CI = 0.3–1.2) although these did not reach statistical significance. The adjusted NNT was lowest for the composite feto-infant morbidity outcome (18), preterm birth (21) and low birth weight (24), and highest for very preterm (86) and very low birth weight (74) events. Conclusions In a disadvantaged community setting, the Healthy Start intervention program was found to reduce the risk for very low birth weight and preterm births by about one-third.

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References

  1. US Department of Health and Human Services. (2000). Healthy People 2010. Understanding and improving health (2nd ed. Vols 1 and 2). Washington, DC: US GPO (http://www.healthypeople.gov/Document/tableofcontents.htm).

  2. Salihu, H. M., Fitzpatrick, L., & Aliyu, M. H. (2005). Racial disparity in fetal growth inhibition among singletons and multiples. American Journal of Obstetrics and Gynecology, 193, 198–203. doi:10.1016/j.ajog.2005.05.021.

    Article  PubMed  Google Scholar 

  3. Salihu, H. M., Sharma, P. P., Kristensen, S., Blot, C., Alio, A. P., Ananth, C. V., et al. (2006). Risk of stillbirth following a cesarean section: Black-white disparity. Obstetrics and Gynecology, 107, 383–390.

    PubMed  Google Scholar 

  4. Salihu, H. M., Aliyu, Z. Y., Pierre-Louis, B. J., Obuseh, F., Druschel, C. M., & Kirby, R. S. (2004). Omphalocele and gastroschisis Black-White disparity in infant survival. Birth Defects Research Part A: Clinical and Molecular Teratology, 70, 586–591. doi:10.1002/bdra.20067.

    Article  CAS  Google Scholar 

  5. Jevitt, C., Zapata, L., Harrington, M., & Berry, E. (2006). Screening for perinatal depression with limited psychiatric resources. Journal of the American Psychiatric Nurses Association, 11, 359–363. doi:10.1177/1078390305284530.

    Article  Google Scholar 

  6. Kramer, M. S., Demissie, K., Yang, H., Platt, R. W., Sauvé, R., & Liston, R. (2000). The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Journal of the American Medical Association, 284, 843–849. doi:10.1001/jama.284.7.843.

    Article  PubMed  CAS  Google Scholar 

  7. Salihu, H. M., Li, Q., Rouse, D. J., & Alexander, G. (2003). Placenta previa: Neonatal mortality after live births in the United States. American Journal of Obstetrics and Gynecology, 188, 1305–1309. doi:10.1067/mob.2003.303.

    Article  PubMed  Google Scholar 

  8. Wilcox, A. J., & Russell, I. T. (1983). Birthweight and perinatal mortality: II On weight specific mortality. International Journal of Epidemiology, 12, 319–325. doi:10.1093/ije/12.3.319.

    Article  PubMed  CAS  Google Scholar 

  9. Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., et al. (2007). Group prenatal care and prenatal outcomes: A randomized controlled trial. Obstetrics and Gynecology, 110, 330–339.

    PubMed  Google Scholar 

  10. Hobel, C. J., Ross, M. G., Bemis, R. L., Bragonier, J. R., Nessim, S., Sandhu, M., et al. (1994). The West Los Angeles Preterm Birth Prevention Project I. Program impact on high-risk women. American Journal of Obstetrics and Gynecology, 170, 54–62.

    PubMed  CAS  Google Scholar 

  11. Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: a randomized controlled trial. Journal of the American Medical Association, 278, 644–652. doi:10.1001/jama.278.8.644.

    Article  PubMed  CAS  Google Scholar 

  12. Heins, H. C., Jr., Nance, N. W., McCarthy, B. J., & Efird, C. M. (1990). A randomized trial of nurse-midwifery prenatal care to reduce low birth weight. Obstetrics and Gynecology, 75, 341–345.

    PubMed  Google Scholar 

  13. Belizan, J. M., Barros, F., Langer, A., Farnot, U., Victora, C., & Villar, J. (1995). Impact of health education during pregnancy on behavior and utilization of health resources. Latin American Network for Perinatal and Reproductive Research. American Journal of Obstetrics and Gynecology, 173, 894–899. doi:10.1016/0002-9378(95)90362-3.

    Article  PubMed  CAS  Google Scholar 

  14. Moore, M. L., Meis, P. J., Ernest, J. M., Wells, H. B., Zaccaro, D. J., & Terrell, T. (1998). A randomized trial of nurse intervention to reduce preterm and low birth weight births. Obstetrics and Gynecology, 91, 656–661. doi:10.1016/S0029-7844(98)00012-X.

    Article  PubMed  CAS  Google Scholar 

  15. Klerman, L. V., Ramey, S. L., Goldenberg, R. L., Marbury, S., Hou, J., & Cliver, S. P. (2001). A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. American Journal of Public Health, 91, 105–111.

    PubMed  CAS  Google Scholar 

  16. Cramer, M. E., Chen, L.-W., Roberts, S., & Clute, D. (2007). Evaluating the social and economic impact of community-based prenatal care. Public Health Nursing, 24, 329–336. doi:10.1111/j.1525-1446.2007.00641.x.

    Article  PubMed  Google Scholar 

  17. Hales, C. N., Barker, D. J. P., Clark, P. M. S., Cox, L. J., Fall, C., & Osmond, C. (1991). Fetal and infant growth and impaired glucose tolerance at age 64. British Medical Journal, 303, 1019–1022.

    Article  PubMed  CAS  Google Scholar 

  18. Ravelli, A. C., van der Meulen, J. H., Michels, R. P., Osmond, C., Barker, D. J. P., & Hales, C. N. (1998). Glucose tolerance in adults after prenatal exposure to famine. Lancet, 351, 173–177. doi:10.1016/S0140-6736(97)07244-9.

    Article  PubMed  CAS  Google Scholar 

  19. Barker, D. J. P., & Osmond, C. (1986). Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet, i, 1077–1081. doi:10.1016/S0140-6736(86)91340-1.

  20. Barker, D. J. P., Osmond, C., Golding, J., Kuh, D., & Wadsworth, M. (1989). Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. British Medical Journal, 298, 564–567.

    PubMed  CAS  Google Scholar 

  21. Alexander, G. R., Kogan, M., Martin, J., & Papiernik, E. (1998). What are the fetal growth patterns of Singletons, Twins and Triplets in the United States? Clinical Obstetrics and Gynecology, 41, 114–125. doi:10.1097/00003081-199803000-00017.

    PubMed  CAS  Google Scholar 

  22. Taffel, S., Johnson, D., & Heuser, R. (1982). A method of imputing length of gestation on birth certificates. Vital and Health Statistics. Series 2, Data Evaluation and Methods Research, 93, 1–11.

  23. Piper, J. M., Mitchel, E. F., Jr., Snowden, M., Hall, C., Adams, M., & Taylor, P. (1993). Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records. American Journal of Epidemiology, 137, 758–768.

    PubMed  CAS  Google Scholar 

  24. Wingate, M. S., Alexander, G. R., Buekens, P., & Vahratian, A. (2007). Comparison of gestational age classifications: date of last menstrual period vs clinical estimate. Annals of Epidemiology, 17, 425–430. doi:10.1016/j.annepidem.2007.01.035.

    Article  PubMed  Google Scholar 

  25. Kogan, M. D., Martin, J. A., Alexander, G. R., Kotelchuck, M., Ventura, S. J., & Frigoletto, F. D. (1998). The changing pattern of prenatal care utilization in the United States, 1981–1995, using different prenatal care indices. Journal of the American Medical Association, 279, 1623–1628. doi:10.1001/jama.279.20.1623.

    Article  PubMed  CAS  Google Scholar 

  26. Clayton, D., & Hills, M. (1993). Statistical models in epidemiology. Oxford, UK: Oxford University Press.

    Google Scholar 

  27. Sackett, D. L., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (1997). Evidence based medicine. London: Churchill Livingstone.

    Google Scholar 

  28. Bjerre, L. M., & LeLorier, J. (2000). Expressing the magnitude of adverse effects in case control studies: “The number of patients needed to be treated for one additional patient to be harmed”. British Medical Journal, 320, 503–506. doi:10.1136/bmj.320.7233.503.

    Article  PubMed  CAS  Google Scholar 

  29. Wilcox, A. J. (2001). On the importance-and the unimportance of birthweight. International Journal of Epidemiology, 30, 1233–1241. doi:10.1093/ije/30.6.1233.

    Article  PubMed  CAS  Google Scholar 

  30. Rich-Edwards, J. W., & Grizzard, T. A. (2005). Psychosocial stress and neuroendocrine mechanisms in preterm delivery. American Journal of Obstetrics and Gynecology, 192, S30–S35.

    Article  PubMed  CAS  Google Scholar 

  31. Cousson-Read, M., Okun, M. L., Schmitt, M. P., & Giese, S. (2005). Prenatal stress alters cytokine levels in a manner that may endanger human pregnancy. Psychosomatic Medicine, 67, 625–631. doi:10.1097/01.psy.0000170331.74960.ad.

    Article  CAS  Google Scholar 

  32. Orr, S. T., James, S. A., & Blackmore, P. C. (2002). Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. American Journal of Epidemiology, 156, 797–802. doi:10.1093/aje/kwf131.

    Article  PubMed  Google Scholar 

  33. Orr, S. T., Retter, J. P., Blazer, D. G., & James, S. A. (2007). Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine, 69, 566–570. doi:10.1097/PSY.0b013e3180cac25d.

    Article  PubMed  Google Scholar 

  34. Dohrenwend, B. S., & Dohrenwend, B. P. (1981). Life stress and illness: Formulation of the issues. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stressful life events and their contexts (pp. 1–27). NewYork: Prodist.

  35. Cohen, S., & Syme, S. L. (1985). Issues in the study and application of social support. In S. Cohen & S. L. Syme (Eds.), Social support and health (pp. 3–22). Orlando: Academic Press.

  36. Thoits, P. A. (1982). Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. Journal of Health and Social Behavior, 23, 145–159. doi:10.2307/2136511.

    Article  PubMed  CAS  Google Scholar 

  37. Barker, D. J., Osmond, C., Simmonds, S. J., & Wield, G. A. (1993). The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. British Medical Journal, 306, 422–426.

    PubMed  CAS  Google Scholar 

  38. Vincer, M. J., Allen, A. C., Joseph, K. S., Stinson, D. A., Scott, H., & Wood, E. (2006). Increasing prevalence of cerebral palsy among very preterm infants: A population-based study. Pediatrics, 118, e1621–e1626. doi:10.1542/peds.2006-1522.

    Article  PubMed  Google Scholar 

  39. Russell, R. B., Green, N. S., Steiner, C. A., Meikle, S., Howse, J. L., Poschman, K., et al. (2007). Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics, 120, e1–e9. doi:10.1542/peds.2006-2386.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported in part by project H49MC00090 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration (HRSA), US Department of Human and Health Services. The funding agency did not play any role in any aspect of the analyses.

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Correspondence to Hamisu M. Salihu.

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Salihu, H.M., Mbah, A.K., Jeffers, D. et al. Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness. Matern Child Health J 13, 56–65 (2009). https://doi.org/10.1007/s10995-008-0400-y

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