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Evaluating the impact of prenatal behavior modification on maternal and infant outcomes: British Columbia’s pregnancy outreach projects Martin, Cheryl Lynn


Since the introduction of enhanced prenatal care programs for high risk women in the late seventies, their effectiveness has been questioned. Recent studies in Canada and the United States have documented mixed results regarding the impact of comprehensive prenatal care programs on infant outcomes. This study was undertaken to explore the impact of British Columbia's Pregnancy Outreach Projects (POP). Data from the UBC Perinatal Study for the years 1990 to 1991, was used to obtain maternal, delivery and birth outcomes data for the 106 POP clients and 318 matched controls included in this study. POP clients obtained on average significantly more prenatal visits (7.9) than their matched controls (7.2). They had slightly better results for initiation of prenatal care, adequacy of prenatal care and maternal morbidity. Although both groups of infants were similar with regard to measures of growth, measures of morbidity were mixed. POP infants had significantly higher rates of preterm birth 15.1% versus 8.8% and congenital anomalies 14.2% versus 4.7%. However, they had a significantly lower rate of small for gestational age, 8.5% versus 12.3%. With the exception of maternal morbidity, early entry POP clients (less than 20 weeks gestation) had significantly better maternal outcomes than their controls. Infant outcomes in the early entry subanalysis mirrored the overall analysis, with significantly less POP infants (6.7%) born small for gestational age compared to their control infants (10.6%). There were no differences in maternal outcomes between POP clients who entered late (between 21 and 28 weeks gestation) and their matched controls. Fewer late entry POP infants were born small for gestational age, though not significantly so. The POP exerted its effect through reductions in the rate of small for gestational age for program infants. This trend was seen for the overall group and in the subanalysis based on entry into the program. Results of the subanalysis based on risk group, showed aboriginal smokers, in addition to single and adolescent Caucasians were the subgroups of POP clients who received the most benefit from the program. Their infants had lower rates of both small for gestational age and preterm birth.

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