Cognitive-Behavioral Therapy Improves Pregnancy Outcomes

Counseling African-American women found to reduce environmental tobacco smoke exposure
By Jeff Muise
HealthDay Reporter

TUESDAY, March 9 (HealthDay News) -- A cognitive-behavioral intervention used in pregnant African-American women reduces their environmental tobacco smoke exposure (ETSE) and the incidence of very low birth weight (VLBW) and very preterm birth (VPTB) among their newborns, according to a study published online March 8 in Pediatrics.

Ayman A.E. El-Mohandes, M.D., of the University of Nebraska Medical Center in Omaha, and colleagues randomized 691 pregnant African-American women, aged 18 years or over, in the Washington, D.C, area who reported ETSE to receive individualized counseling or usual prenatal care. The researchers also analyzed a subset of 520 women with salivary cotinine levels (SCLs) less than 20 ng/mL. The researchers calculated ETSE prior to delivery and its association with adverse pregnancy outcomes.

The researchers found that the counseled women were less likely to report ETSE before delivery than the usual-care group (odds ratio, 0.50) and also had lower rates of VLBW (odds ratio, 0.11) and VPTB (odds ratio, 0.22). Reported intimate partner violence at baseline increased risk of VLBW (odds ratio, 3.75) or VPTB (odds ratio, 2.71). Women on Medicaid were more likely to have ETSE (odds ratio, 1.97), while ETSE decreased with older maternal age (odds ratio, 0.96). Age was not a factor for women with SCL of less than 20 ng/mL.

"This is the first randomized clinical trial demonstrating efficacy of a cognitive-behavioral intervention targeting ETSE in pregnancy. We significantly reduced ETSE as well as VPTB and VLBW, leading causes of neonatal mortality and morbidity in minority populations. This intervention may reduce health disparities in reproductive outcomes," the authors write.

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