Maternal Health Risk Assessment and Behavioral Intervention in the NICU Setting Following Very Low Birth Weight Delivery

Abstract

Objectives To investigate whether maternal health risk assessment and behavioral intervention in the neonatal intensive care unit (NICU) improves women's health care seeking and health behaviors following the birth of a very low birth weight (VLBW) infant. Methods Using a quasi-experimental non-equivalent control group pretest/posttest design, 80 women who had given birth to a VLBW infant that was admitted to the NICU were enrolled into one of two cohorts: 40 into a 'Minimal Intervention' cohort, who received a single session risk assessment and health education pamphlets, and 40 into an 'Enhanced Intervention' cohort, who received five counseling sessions targeting identified risks. The proportion of women with specific health care seeking and health behaviors in the two cohorts were compared at baseline and 3- and 9-months post-intervention. Results Women in the Enhanced Intervention cohort were more likely to attend the postpartum visit (73 % vs. 48 %; p = 0.04), ingest folic acid daily (65 % vs. 19 %, p < 0.001), and correctly and consistently use a method of contraception (82 % vs. 63 %, p = 0.03) over the 9-month follow-up period. In multivariate analysis, the between-cohort differences in daily folic acid use (aOR = 3.45, 95 % CI 1.61-7.40) and correct and consistent use of a method of contraception (aOR = 1.46, 95 % CI 1.05-2.06) remained statistically significant at 9-months and the reduction in risk of unintended pregnancy nearly achieved statistical significance (aOR = 0.62, 95 % CI 0.12-1.0). Conclusions for Practice This study provides support for the implementation of maternal risk assessment and behavioral intervention in the NICU setting to promote women's positive health care seeking and health behaviors.

Developing a Comprehensive Midwifery Assessment Tool: Seeing the Whole Person

“…The annual preventive visit is an ideal opportunity to collect this robust snapshot of a patient's health. The resulting data can easily be tied to follow‐up and intervention targeting assessed risks in order to effect change 11,16 …”

“…A 2016 study analyzed the potential of an HRA to reduce the recurrence of very low birth weight. In addition to collecting reproductive and personal health information, health care providers delivered a targeted, short‐term intervention to postpartum participants in the treatment arm of the study 16 . At 9 months, the treatment group reported increased adherence to health recommendations, including consistent use of contraception, daily folic acid supplementation, and adherence to chronic disease treatments 16 .…”

“…In addition to collecting reproductive and personal health information, health care providers delivered a targeted, short‐term intervention to postpartum participants in the treatment arm of the study 16 . At 9 months, the treatment group reported increased adherence to health recommendations, including consistent use of contraception, daily folic acid supplementation, and adherence to chronic disease treatments 16 . Although this study did not track birth outcomes in the subsequent pregnancies, the enhancement of patient knowledge and awareness demonstrates the benefits of an HRA process that includes both risk assessment and application of targeted interventions.…”