Elsevier

Women's Health Issues

Volume 18, Issue 6, Supplement, November–December 2008, Pages S87-S96
Women's Health Issues

Policy and Financing Issues for Preconception and Interconception Health
Improving Women's Preconceptional Health: Findings from a Randomized Trial of the Strong Healthy Women Intervention in the Central Pennsylvania Women's Health Study

https://doi.org/10.1016/j.whi.2008.07.008Get rights and content

Purpose

Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child. This paper reports the first pretest–posttest results from a randomized trial of a unique, multidimensional, small group format intervention, Strong Healthy Women, designed to improve the health behaviors and health status of preconceptional and interconceptional women.

Methods

Nonpregnant pre- and interconceptional women ages 18–35 were recruited in 15 low-income rural communities in Central Pennsylvania (n = 692). Women were randomized in a ratio of 2-to-1 to intervention and control groups; participants received a baseline and follow-up health risk assessment at 14 weeks and completed questionnaires to assess behavioral variables. The analytic sample for this report consists of 362 women who completed both risk assessments. Outcomes include measures of attitudinal and health-related behavior change.

Main Findings

Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes; greater intent to eat healthy foods and be more physically active; and greater frequency of reading food labels, physical activity consistent with recommended levels, and daily use of a multivitamin with folic acid. Significant dose effects were found: Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes, reading food labels, engaging in relaxation exercise or meditation for stress management, and daily use of a multivitamin with folic acid.

Conclusions

The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity. These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions.

Section snippets

The Central Pennsylvania Women's Health Study

The Strong Healthy Women intervention was developed as part of the Central Pennsylvania Women's Health Study (CePAWHS), funded by the Pennsylvania Department of Public Health (Miller et al., 2007, Weisman et al., 2006). CePAWHS consisted of 2 phases. In the first phase, population-based survey data were collected for women of reproductive age to ascertain the prevalence of multiple risk factors for adverse pregnancy outcomes in a 28-county region of Central Pennsylvania. This region was chosen

Overall study design

A randomized controlled trial of the Strong Healthy Women intervention was conducted in 15 low-income rural communities within the 28-county Central Pennsylvania region. Low-income rural communities were targeted because women in these communities were shown to have high rates of risk factors for adverse pregnancy outcomes in the Phase I CePAWHS population-based surveys.

The randomized trial study design is shown in Figure 1. The study was approved by the Penn State College of Medicine

Results

For descriptive purposes, the sociodemographic characteristics of the analytic sample are shown in Table 1. The sample is quite diverse with respect to all sociodemographic variables except for race/ethnicity (reflecting the demographics of the population in the targeted low-income rural communities) and with respect to health care access (i.e., having a regular source of health care and health insurance status). No statistically significant differences in the sociodemographic characteristics

Discussion

This is the first report of findings from the CePAWHS randomized, controlled trial assessing the effectiveness of a behavior change intervention designed to improve the health of preconceptional and interconceptional women. The Strong Healthy Women intervention is a unique group format program targeting multiple health-related behaviors that are related to pregnancy outcomes. This initial randomized trial with pre- and interconceptional women recruited in low-income rural communities

Acknowledgments

This work would not have been possible without the substantial contributions of our late colleague, Gary A. Chase, PhD, who designed the randomized trial and conducted the main analyses. He is greatly missed.

Marianne M. Hillemeier, PhD, is a sociologist/demographer with research interests in maternal and child health disparities.

References (31)

  • A. Bandura

    Social foundations of thought and action

    (1986)
  • A.T. Bhutta et al.

    Cognitive and behavioral outcomes of school-aged children who were born preterm: A meta-analysis

    JAMA

    (2002)
  • Centers for Disease Control and Prevention (CDC)

    Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care

    MMWR

    (2006)
  • Diabetes Prevention Research Group

    The diabetes prevention research group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

    New England Journal of Medicine

    (2002)
  • D.S. Downs et al.

    Design of the Central Pennsylvania Women's Health Study (CePAWHS) Strong Healthy Women intervention: Improving preconceptional health

    Maternal and Child Health Journal

    (2008)
  • Cited by (61)

    • Women's dietary changes before and during pregnancy: A systematic review

      2017, Midwifery
      Citation Excerpt :

      Similarly the decrease of consumption in fast food reported (Smedley et al., 2014) could be due to public health education programmes in Australia relating to foods not to eat to avoid Listeria (Anderson, 2001). Indeed, previous research has suggested that health education around effective weight management can affect weight gain during pregnancy (Wilkinson et al., 2009), with further evidence to suggest that pre-conception interventions can improve both the intention and self-efficacy of healthy eating behaviours during pregnancy (Hillemeier et al., 2008). There is also emerging evidence to suggest that women start eating healthily in preparation for pregnancy (Ramage et al., 2015).

    View all citing articles on Scopus

    Marianne M. Hillemeier, PhD, is a sociologist/demographer with research interests in maternal and child health disparities.

    Danielle Symons Downs, PhD, is an exercise psychology researcher whose interests include understanding the psychosocial and behavioral correlates of exercise in women and children.

    Mark E. Feinberg, PhD, is a psychologist whose research focuses on family and community preventive programs.

    Carol S. Weisman, PhD, is a sociologist and health services researcher with a principal interest in women's health care

    Cynthia H. Chuang, MD, is a general internist with research interests in reproductive health care for women with chronic medical conditions.

    Roxanne Parrott, PhD, is a health communication researcher with specific interests in women's health.

    Diana Velott, MPA, is an instructor in health services research and project coordinator for a multisite study of fertility patterns following cesarean section delivery.

    Lori A. Francis, PhD, is a developmental psychologist with research interests in eating behaviors and the family environment.

    Sara A. Baker, PhD, is project director for the Central Pennsylvania Women's Health Study.

    Anne-Marie Dyer, MS, is the data manager and chief data analyst for the Central Pennsylvania Women's Health Study.

    Vernon M. Chinchilli, PhD, is a biostatistician with interests in clinical trails research.

    The authors have no direct financial interests that might pose a conflict of interest in connection with the submitted manuscript.

    Funded, in part, under grant number 4100020719 with the Pennsylvania Department of Health. The department specifically disclaims responsibility for any analyses, interpretations, or conclusions.

    View full text