Central Pennsylvania Center of Excellence to Improve Pregnancy Outcome

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Central Pennsylvania Center of Excellence to
Improve Pregnancy Outcome
Botti JJ, Weisman CS, Hillemeier MA, Baker SA
The Central Pennsylvania Center of Excellence for
Research on Pregnancy Outcomes (COE) is funded by
a Pennsylvania Department of Health non-formula
tobacco settlement grant awarded in June 2004.
The COE is a partnership of Pennsylvania State
Universitys main and medical campuses, Franklin
Marshall College, Lock Haven University of
Pennsylvania, and the Family Health Council of
Central Pennsylvania to address health
disparities in women who may become pregnant in
this region. The primary research project
conducted in the COE is the Central PA Womens
Health Study (CePAWHS). The purpose of CePAWHS is
to assess and improve the health of reproductive
age women in a 28 county predominantly rural
region of Central PA (see map, Fig. 1). The
research focuses on reducing disparities in
preterm birth and low birthweight, which are
persistent public health problems in the nation
and in Pennsylvania. More than 40
years of scientific study on the prevention of
preterm birth and low birthweight have improved
our understanding of some of the mechanisms that
lead to preterm birth and low birthweight, but
multiple therapeutic interventions have not
substantially reduced the rates of prematurity
and low birthweight, nor have they eliminated
racial/ethnic disparities in these pregnancy
outcomes. Prematurity is disproportionately
greater among women of color and families in
poverty in Central PA, as in other regions. This
program uses a preconception, multiple-determinant
s, life-stage model (Misra, 2003) of perinatal
health to identify environmental, psychosocial,
biological, and health care risk factors that may
account for disparities in birth outcomes and
that are amenable to population-based
interventions to improve womens health before
they become pregnant. (Fig. 2) T
he COE will research the risks for preterm birth
and low birthweight (LBW) in diverse populations
in the region provide a structure for testing
innovative population-based interventions in
partnership with the communities and provide
education to collegiate undergraduate, physician
assistant and medical students, and new
investigators through coursework and mentored
research to improve pregnancy outcomes through
research and practice. Continuing education will
also be designed for health professionals working
in the geographical study areas.
CePAWHS is an unique, two-phase research project
designed to reduce the incidence of preterm birth
(birth occurring before 37 weeks of gestation)
and low birthweight babies (babies that weigh
less than 5 1/2 pounds at birth) by improving the
health of high-risk women before they become
pregnant. The first phase, CePAWHS-1, is a survey
of 2,300 women ages 18-45 who reside in the
28-county study region in Central Pennsylvania
and of 300 16-17-year-olds seeking services in
family planning clinics. The purpose of the
survey is to gather information on the health
status, health habits, pregnancy history, and
patterns of health care use of women in our
target population and to identify the key risk
factors for preterm birth and low birthweight in
the population. This is the first comprehensive
survey ever conducted on the health of
reproductive-age, Central Pennsylvania
women. The survey is being conducted by
telephone, household interviews, and clinic-based
interviews. Baseline survey analysis will be
completed in 2005. The information obtained in
the survey will help the investigators design a
program that will be tested in phase 2 of the
research. The second phase, CePAWHS-2, is a
special program designed to help women who are
considering a future pregnancy to improve their
health status and health habits. Using the
findings about key risk factors from phase 1, the
researchers will develop a program to improve
women's health literacy, teach behavior change
skills, and provide selected health services. The
program will be tested in a randomized trial that
includes baseline and follow-up risk assessments.
Improved understanding of the bio-behavioral
mechanisms associated with preterm birth and low
birthweight in the CePAWHS target population of
reproductive-age women should lead to innovative
pre-pregnancy approaches to diagnoses and
therapeutic interventions to improve pregnancy
outcomes.
PROXIMAL DETERMINANTS Psychosocial stress and
stress- related behavior Acute/chronic
stressors depression/anxiety tobacco use
alcohol/drug use poor nutrition physical
inactivity Chronic Conditions Hypertension
diabetes asthma obesity Infections Bacterial
vaginosis vaginal douching sexually
transmitted infections Pregnancy History
Previous preterm birth maternal complications
(pre-eclampsia, gestational diabetes)
inter-pregnancy interval contraceptive
use infertility issues
DISTAL DETERMINANTS Community size (rural ?
urban) Sociodemographics (age, race/ethnicity,
SES, etc.) Family context (marital status,
household composition) Environmental/occupational
exposures Genetic factors
OUTCOMES Preterm birth Low birthweight Predispo
sition to lifetime complications
HEALTH CARE (MODIFIERS) Use patterns Health
information sources/ health literacy Access
barriers
Fig. 2. Conceptual Framework Determinants of
Preterm Birth and LBW (adapted from Misra et al.
2003)
Fig 1. CePaWHS study area
CePAWHS (Central Pennsylvania Womens Health
Study)
www.womenshealthcoe.psu.edu