BEST PRACTICES TO REDUCE
LOW BIRTH WEIGHT IN
HIGH-RISK POPULATIONS
NS 400
UNIVERSITY OF ALASKA ANCHORAGE
Kylie Brown, Kayla Williams, Casey Vralsted,
Summer Hamrick, and Kelly Paldanius
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).
Searchable Question

What are significant
interventions for preventing low
birth weight newborns in highrisk populations?
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
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
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

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
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
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
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.
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

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
Stakeholders
Maternity nurses & staff
 Surgeons
 Physicians
 Patients & family
 Intervention funding
sources
 Hospital administration

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.

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).
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).
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 (ElMohandes et al, 2011
– Level II).
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.
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.
Evaluation Plan




Feedback questionnaires from participants.
Audit medical records of LBW newborns and mothers.
Monitor statistics of program participation.
Funding audits every year.
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.
References

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
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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.
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 hispanic women.
Journal of Midwifery & Women’s Health, 57(5), 476-481.
Willems Van 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.