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Obstetrics & Gynecology 2008;112:611-620
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

An Intervention to Improve Postpartum Outcomes in African-American Mothers

A Randomized Controlled Trial

Ayman A. E. El-Mohandes, MD, MPH1, Michele Kiely, DrPH2, Jill G. Joseph, MD, PhD3, Siva Subramanian, MD4, Allan A. Johnson, PhD, LN5, Susan M. Blake, PhD, LCP1, Marie G. Gantz, PhD6 and M. Nabil El-Khorazaty, PhD6

From the 1George Washington University, Washington, DC; 2National Institutes of Health, Bethesda, Maryland; 3Children’s National Medical Center, Washington, DC; 4Georgetown University, Washington, DC; 5Howard University, Washington, DC; and 6Research Triangle Institute International, Rockville, Maryland.

OBJECTIVE: To evaluate the efficacy of an integrated multiple risk intervention, delivered mainly during pregnancy, in reducing such risks (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) postpartum.

METHODS: Data from this randomized controlled trial were collected prenatally and on average 10 weeks postpartum in six prenatal care sites in the District of Columbia. African Americans were screened, recruited, and randomly assigned to the behavioral intervention or usual care. Clinic-based, individually tailored counseling was delivered to intervention women. The outcome measures were number of risks reported postpartum and reduction of these risks between baseline and postpartum.

RESULTS: The intervention was effective in significantly reducing the number of risks reported in the postpartum period. In bivariate analyses, the intervention group was more successful in resolving all risks (47% compared with 35%, P=.007, number needed to treat=9, 95% confidence interval [CI] 5–31) and in resolving some risks (63% compared with 54%, P=.009, number needed to treat=11, 95% CI 7–43) as compared with the usual care group. In logistic regression analyses, women in the intervention group were more likely to resolve all risks (odds ratio 1.86, 95% CI 1.25–2.75, number needed to treat=7, 95% CI 4–19) and resolve at least one risk (odds ratio 1.60, 95% CI 1.15–2.22, number needed to treat=9, 95% CI 6–29).

CONCLUSION: An integrated multiple risk factor intervention addressing psychosocial and behavioral risks delivered mainly during pregnancy can have beneficial effects in risk reduction postpartum.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00381823

LEVEL OF EVIDENCE: I






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