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Lessons learned from the Philadelphia Collaborative Preterm Prevention Project: the prevalence of risk factors and program participation rates among women in the intervention group.

Webb DA, Mathew L, Culhane JF - BMC Pregnancy Childbirth (2014)

Bottom Line: Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions.Participation rates associated with the PCPPP treatments or services varied markedly, and were quite low in some cases, despite considerable efforts to reduce the barriers to receiving care.The efficacy of individual level risk-reduction efforts designed to prevent preterm/repeat preterm in the pre- or inter-conception period may be limited if participation rates associated with interventions to reduce major risk factors for PTB are low.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital of Philadelphia, National Children's Study Center, 3535 Market Street, Philadelphia, PA, 19104, USA. webbd@email.chop.edu.

ABSTRACT

Background: Women who deliver preterm infants are at a much greater risk for repeating a preterm birth (PTB), compared to women without a history of PTB. However, little is known about the prevalence of the risk factors which account for this markedly increased risk. Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions.

Methods: The Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large randomized control trial designed to identify and reduce six major risk factors for a repeat preterm birth among women immediately following the delivering of a preterm infant. For the women assigned to the PCPPP treatment group, we calculated the prevalence of the six risk factors in question, the percentages of women who agreed to receive high quality risk-appropriate treatments or services, and the of rates of participation among those who were offered and eligible for these treatments or services.

Results: Urogenital tract infections were identified in 57% of the women, while 59% were found to have periodontal disease. More than 39% were active smokers, and 17% were assessed with clinical depression. Low literacy, and housing instability were identified in, 22 and 83% of the study sample, respectively. Among women eligible for intervention, the percentages who accepted and at least minimally participated in treatment ranged from a low of 28% for smoking, to a high of 85% for urogenital tract infection. Most PCPPP enrollees (57%) had three or more major risk factors. Participation rates associated with the PCPPP treatments or services varied markedly, and were quite low in some cases, despite considerable efforts to reduce the barriers to receiving care.

Conclusion: The efficacy of individual level risk-reduction efforts designed to prevent preterm/repeat preterm in the pre- or inter-conception period may be limited if participation rates associated with interventions to reduce major risk factors for PTB are low. Achieving adequate participation may require identifying, better understanding, and eliminating barriers to access, beyond those associated with cost, transportation, childcare, and service location or hours of operation.

Trial registration: ClinicalTrials.gov ( NCT01117922 ).

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Distribution of risk factors for PCPPP intervention group.
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Fig1: Distribution of risk factors for PCPPP intervention group.

Mentions: As Figure 1 shows, 6 percent of women had no identified risk factors, 14 percent had only one risk factor, 22 percent had two risk factors, 31.4 percent had three risk factors and 25.9 percent had 4 or more major risk factors for a PTB. Prevalence rates for each of the major risk factors assessed are presented in Table 3. Of the women in the study sample 57.3 percent were diagnosed with urogenital tract infection, and 58.6 percent with periodontal disease. About 39 percent of women in the intervention group were identified as cigarette smokers. Just over 60 percent of the women had CES-D scores of >16; of these 81 or 17.2 percent were determined to be clinically depressed. A total of 106 or 22.5 percent of enrollees were determined to be reading at low levels of literacy. The assessment of housing conditions revealed that 392 of the women, or 83.2 percent, were living in an unstable housing situation.Figure 1


Lessons learned from the Philadelphia Collaborative Preterm Prevention Project: the prevalence of risk factors and program participation rates among women in the intervention group.

Webb DA, Mathew L, Culhane JF - BMC Pregnancy Childbirth (2014)

Distribution of risk factors for PCPPP intervention group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230507&req=5

Fig1: Distribution of risk factors for PCPPP intervention group.
Mentions: As Figure 1 shows, 6 percent of women had no identified risk factors, 14 percent had only one risk factor, 22 percent had two risk factors, 31.4 percent had three risk factors and 25.9 percent had 4 or more major risk factors for a PTB. Prevalence rates for each of the major risk factors assessed are presented in Table 3. Of the women in the study sample 57.3 percent were diagnosed with urogenital tract infection, and 58.6 percent with periodontal disease. About 39 percent of women in the intervention group were identified as cigarette smokers. Just over 60 percent of the women had CES-D scores of >16; of these 81 or 17.2 percent were determined to be clinically depressed. A total of 106 or 22.5 percent of enrollees were determined to be reading at low levels of literacy. The assessment of housing conditions revealed that 392 of the women, or 83.2 percent, were living in an unstable housing situation.Figure 1

Bottom Line: Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions.Participation rates associated with the PCPPP treatments or services varied markedly, and were quite low in some cases, despite considerable efforts to reduce the barriers to receiving care.The efficacy of individual level risk-reduction efforts designed to prevent preterm/repeat preterm in the pre- or inter-conception period may be limited if participation rates associated with interventions to reduce major risk factors for PTB are low.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital of Philadelphia, National Children's Study Center, 3535 Market Street, Philadelphia, PA, 19104, USA. webbd@email.chop.edu.

ABSTRACT

Background: Women who deliver preterm infants are at a much greater risk for repeating a preterm birth (PTB), compared to women without a history of PTB. However, little is known about the prevalence of the risk factors which account for this markedly increased risk. Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions.

Methods: The Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large randomized control trial designed to identify and reduce six major risk factors for a repeat preterm birth among women immediately following the delivering of a preterm infant. For the women assigned to the PCPPP treatment group, we calculated the prevalence of the six risk factors in question, the percentages of women who agreed to receive high quality risk-appropriate treatments or services, and the of rates of participation among those who were offered and eligible for these treatments or services.

Results: Urogenital tract infections were identified in 57% of the women, while 59% were found to have periodontal disease. More than 39% were active smokers, and 17% were assessed with clinical depression. Low literacy, and housing instability were identified in, 22 and 83% of the study sample, respectively. Among women eligible for intervention, the percentages who accepted and at least minimally participated in treatment ranged from a low of 28% for smoking, to a high of 85% for urogenital tract infection. Most PCPPP enrollees (57%) had three or more major risk factors. Participation rates associated with the PCPPP treatments or services varied markedly, and were quite low in some cases, despite considerable efforts to reduce the barriers to receiving care.

Conclusion: The efficacy of individual level risk-reduction efforts designed to prevent preterm/repeat preterm in the pre- or inter-conception period may be limited if participation rates associated with interventions to reduce major risk factors for PTB are low. Achieving adequate participation may require identifying, better understanding, and eliminating barriers to access, beyond those associated with cost, transportation, childcare, and service location or hours of operation.

Trial registration: ClinicalTrials.gov ( NCT01117922 ).

Show MeSH
Related in: MedlinePlus