Transcript Document

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 University’s 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 Women’s 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.
greater among women of color and families in poverty in
Central PA, as in other regions.
This program uses a preconception, multipledeterminants, 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 populationbased interventions to improve women’s health
before they become pregnant. (Fig. 2)
PROXIMAL DETERMINANTS
DISTAL DETERMINANTS
Psychosocial stress and stressrelated behavior: Acute/chronic stressors;
depression/anxiety; tobacco use; alcohol/drug
use; poor nutrition; physical inactivity
Community size
(rural  urban)
Chronic Conditions: Hypertension; diabetes;
asthma; obesity
Sociodemographics (age,
race/ethnicity, SES, etc.)
Infections: Bacterial vaginosis; vaginal
douching; sexually transmitted infections
Family context (marital status,
household composition)
Pregnancy History: Previous preterm birth;
maternal complications (pre-eclampsia, gestational
diabetes); inter-pregnancy interval; contraceptive
use;
infertility issues
Environmental/occupational
exposures
OUTCOMES
Preterm birth
Predisposition 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)
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
ever conducted on the health of reproductive-age,
Central Pennsylvania women.
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.
Definition
PA Rate
2002
Healthy People
2010 Goal
Preterm
Birth
< 37 weeks
gestation
9.9%
7.6%
LBW
<2,500 grams
8.2%
5.0%
Low birthweight
Genetic factors
Fig 1. CePaWHS study area
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
The 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.
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.
Fig. 3. Pennsylvania preterm birth and low birth
weight rates, 2002.
CePAWHS (Central Pennsylvania Women’s Health Study)
www.womenshealthcoe.psu.edu