Design of the Central Pennsylvania Women’s Health Study (CePAWHS) Strong Healthy Women Intervention: Improving Preconceptional Health

Abstract

Considerable evidence suggests that modifiable risk factors for adverse pregnancy outcomes such as preterm birth and low birthweight include obesity, sedentary behavior, and infections. There is a growing consensus that the preconceptional and interconceptional periods may be an ideal time for preventive intervention targeting these risk factors; enhancing health before pregnancy would subsequently reduce the risk for poor pregnancy outcomes. This paper provides an overview of the development of a health behavior intervention, Strong Healthy Women, that aims to improve women's preconceptional and interconceptional health. We describe the rationale, delivery, and targeted outcomes of the program, as well as the design of an ongoing trial currently testing program efficacy. The content areas are also discussed and include pregnancy-conception, stress, physical activity, nutrition, infection, sources of smoke in the home, and substance use. This intervention protocol may offer researchers and healthcare professionals a framework for designing other programs aiming to improve women's preconceptional health.

The Contribution of Maternal Stress to Preterm Birth: Issues and Considerations

“…Accordingly, studies are currently underway to test the effects of preconceptional health interventions on pregnancy and birth outcomes (see, e.g. 233–235 ).…”

Improving Women's Preconceptional Health

“…Detailed description of the development of this intervention is available elsewhere (Downs et al, 2008). Briefly, the rationale for the targets and approach of the group format, multisession intervention was based on 3 primary considerations: 1) the risk factors identified in CePAWHS Phase I; 2) prior successful behavior change interventions such as the Diabetes Prevention Program (Diabetes Prevention Research Group, 2002) and WISEWOMAN (Viadro, Farris, & Will, 2004; Will, Farris, Sanders, Stockmyer, & Finkelstein, 2004; Will et al, 2001); and 3) the social cognitive approach to behavior change.…”

“…The Centers for Disease Control and Prevention (CDC, 2006) recommends a multipronged strategy for improving women's health before pregnancy through greater access to clinical care, community-based health promotion programs, and a focus on individuals’ health-related behavior. Addressing the latter 2 points, we developed the Strong Healthy Women intervention to improve health-related behaviors, attitudes, and health status among pre- and interconceptional women recruited in community settings (Downs et al, 2008). This paper reports the pretest–posttest results of a randomized trial of this unique multidimensional behavior change intervention.…”

Improving Women’s Preconceptional Health: Long-Term Effects of the Strong Healthy Women Behavior Change Intervention in the Central Pennsylvania Women’s Health Study

“…The Strong Healthy Women intervention was developed by the investigator team of the Central Pennsylvania Women’s Health Study, based on the social cognitive approach to behavior change, and it was designed to improve the health-related attitudes and behaviors and health status of pre- and interconceptional women (Downs et al, 2009). The six-session, small-group intervention, conducted over a 12-week period in community settings, focuses on modifying behaviors related to key risks for adverse pregnancy outcomes such as preterm birth and low birthweight.…”

“…The six-session, small-group intervention, conducted over a 12-week period in community settings, focuses on modifying behaviors related to key risks for adverse pregnancy outcomes such as preterm birth and low birthweight. These risks include poor nutrition, low physical activity, tobacco and alcohol use and exposure, unhealthy coping with stress, gynecologic infections, and inadequate pregnancy planning or spacing (Downs et al, 2009; Weisman et al, 2006). The group format was intended to motivate women through social support from peers and the lay group facilitators.…”