PREVENTING PRETERM DELIVERY: TESTING THE EFFECTIVENESS OF A PRENATAL CARE INTERVENTION FOR HIGH RISK BLACK AND HISPANIC WOMEN.
Contributors: Columbia University.
Published: 1989
Number of pages: 293
Subjects: Health Sciences, Public Health.; Health Sciences, Medicine and Surgery.; Health Sciences, Nursing.
Description: New York City's Harlem Hospital Center introduced its Prevention of Prematurity Project in June 1984. These clinics included patients who presented for prenatal care by 26 weeks of gestation and met at least one of the following criteria associated with high risk for preterm birth: previous preterm birth, previous late fetal death, less than 17 or 35 or more years of age. Experimental components of care included weekly appointment including cervical examination, increased social worker access, and intensive follow-up of missed appointment. A randomly-selected half also received instructions of self-palpation of the uterus for recognition of early labor contractions, and weekly discussion of physical activity levels. These components were designed to increase both the prevention and the early detection of preterm labor.

Pregnancy outcomes were compared, adjusting for maternal characteristics, for the 227 women invited to attend the new clinics (of whom 80% received the enhanced care) with 370 women meeting the same eligibility criteria who attended the hospital's clinics in the two preceding years for a test of program effectiveness.

Length of gestation and birthweight were treated as continuous dependent variables and then as various dichotomies along with five minute Apgar scores in OLS and logistic multiple regressions. The presence of the intervention changed none of these measures significantly. Due to language constraints, hispanics and blacks were considered separately. Blacks in the intervention group were twice as likely to deliver after 36 completed weeks than were blacks in the standard clinics (Odds Ratio = 2.04 with 95% Confidence Interval 1.06-3.90), and had gestations three days longer. The intervention clinics did not significantly affect the preterm rate of the hispanics of all races enrolled (Odds Ratio = 0.75, 95% Confidence Interval 0.26-2.16). When examined by strata defined by eligibility criterion as well as ethnicity, all black strata showed positive yet non-significant effects of the intervention while the hispanic strata non-significant coefficients ranged from negative to positive. Preliminary examination of the small samples stratified by intervention subclinic indicated that the Special intervention may be of particular help to patients while the Basic Intervention alone may be associated with a decreased gestation for hispanic patients.
Notes: Source: Dissertation Abstracts International, Volume: 50-05, Section: B, page: 1883.

Thesis (PH.D.)--COLUMBIA UNIVERSITY, 1989.

School code: 0054.