El-Mohandes Ayman A E, Kiely Michele, Joseph Jill G, Subramanian Siva, Johnson Allan A, Blake Susan M, Gantz Marie G, El-Khorazaty M Nabil
George Washington University, Washington, DC, USA.
Obstet Gynecol. 2008 Sep;112(3):611-20. doi: 10.1097/AOG.0b013e3181834b10.
To evaluate the efficacy of an integrated multiple risk intervention, delivered mainly during pregnancy, in reducing such risks (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) postpartum.
Data from this randomized controlled trial were collected prenatally and on average 10 weeks postpartum in six prenatal care sites in the District of Columbia. African Americans were screened, recruited, and randomly assigned to the behavioral intervention or usual care. Clinic-based, individually tailored counseling was delivered to intervention women. The outcome measures were number of risks reported postpartum and reduction of these risks between baseline and postpartum.
The intervention was effective in significantly reducing the number of risks reported in the postpartum period. In bivariate analyses, the intervention group was more successful in resolving all risks (47% compared with 35%, P=.007, number needed to treat=9, 95% confidence interval [CI] 5-31) and in resolving some risks (63% compared with 54%, P=.009, number needed to treat=11, 95% CI 7-43) as compared with the usual care group. In logistic regression analyses, women in the intervention group were more likely to resolve all risks (odds ratio 1.86, 95% CI 1.25-2.75, number needed to treat=7, 95% CI 4-19) and resolve at least one risk (odds ratio 1.60, 95% CI 1.15-2.22, number needed to treat=9, 95% CI 6-29).
An integrated multiple risk factor intervention addressing psychosocial and behavioral risks delivered mainly during pregnancy can have beneficial effects in risk reduction postpartum.
评估主要在孕期实施的综合多风险干预措施在降低产后此类风险(吸烟、接触环境烟草烟雾、抑郁和亲密伴侣暴力)方面的效果。
在哥伦比亚特区的六个产前护理点收集了这项随机对照试验的数据,分别在产前和产后平均10周时进行。对非裔美国人进行筛查、招募,并随机分配到行为干预组或常规护理组。为干预组妇女提供基于诊所的个性化咨询。结局指标为产后报告的风险数量以及基线与产后之间这些风险的降低情况。
该干预措施在显著降低产后报告的风险数量方面有效。在双变量分析中,与常规护理组相比,干预组在解决所有风险(47% 对 35%,P = 0.007,治疗所需人数 = 9,95% 置信区间 [CI] 5 - 31)和解决部分风险(63% 对 54%,P = 0.009,治疗所需人数 = 11,95% CI 7 - 43)方面更成功。在逻辑回归分析中,干预组的妇女更有可能解决所有风险(优势比 1.86,95% CI 1.25 - 2.75,治疗所需人数 = 7,95% CI 4 - 19)并解决至少一项风险(优势比 1.60,95% CI 1.15 - 2.22,治疗所需人数 = 9,95% CI 6 - 29)。
主要在孕期实施的针对心理社会和行为风险的综合多风险因素干预措施对降低产后风险可能具有有益效果。