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William F. Connell School of Nursing

COPE for Pregnant Hispanic Women &
Mechanisms Underlying Preterm Birth in Minority Women

nursing research


COPE for Pregnant Hispanic Women

(in recruitment and data collection phase)

Anxiety, depression, and poor coping behaviors have been linked to poor birth outcomes such as preterm birth and low birth weight. Cognitive Behavioral Therapy (CBT) has been shown to be an effective intervention to reduce anxiety and address poor coping behaviors. Research studies show that CBT is safe in pregnancy, and some studies suggest it is preferred to pharmacological therapies in pregnant women.

The COPE Intervention (Creating Opportunities for Personal Empowerment) is a CBT-based program that has been used with parents of premature babies. It has significantly reduced stress, anxiety and depression, improved how parents care for and interact with their babies, and has shortened the amount of time the baby is in the hospital. Dr. Susan Gennaro and her research team have tailored the COPE Intervention for pregnant Hispanic women to address identified concerns found in the literature, focus groups and interviews. The team has adapted the intervention for pregnant Hispanic women, who are known to be at higher risk for poor birth outcomes than are other ethnic groups. As is common in cognitive behavioral skill building programs, the COPE intervention focusses on providing skills to connect thinking, feeling, and behaving. The COPE intervention includes teaching women techniques to: identify triggers to certain behaviors, identify automatic negative thoughts, encourage positive self-talk, stay in the moment, encourage self-esteem, and learn positive coping techniques. Additionally, the intervention helps women learn steps to set goals and encourage positive change as well as to identify signs of stress, depression, and anxiety and to learn skills to manage these emotions. The women also learn how to problem solve, overcome barriers, deal with emotions in healthy ways, and cope with stressful situations.

The specific aims of this pilot study are to test the following aspects of the COPE program for young Hispanic pregnant women as compared to standard care:

  1. Feasibility; The feasibility will be measured by the average number of sessions completed per group as well as individual attrition rates.
  2. Acceptability; The acceptability will be assessed by the COPE Evaluation Tool.
  3. Efficacy; The effectiveness will be measured by changes on 7 unique surveys administered pre- and post- intervention, a 24-hour diet recall, and changes in level of physical activity.       

The data collected from this study will provide support for the proposed grant application to examine the effectiveness of COPE intervention and its ability to improve the psychological and physical well-being of pregnant Hispanic women.

Mechanisms Underlying Preterm Birth in Minority Women
(in data analysis and manuscript preparation phase)

 

Susan Gennaro, Connell School Dean and Professor


Preterm birth
is a serious concern, with many possible heath complications for the infant. This issue is of particular concern for minority women, who experience a significantly higher incidence of preterm birth. Identifying factors that predict preterm birth early in pregnancy is an important step toward decreasing preterm birth in minority women.

In African American women, most at risk for early preterm birth (<32 weeks gestation), mechanisms underlying preterm labor will be differentiated from those underlying preterm birth. As only 40-50% of preterm labor ends in PTB, understanding factors that differentiate preterm labor from preterm birth would enable clinicians to provide more effective care for preterm labor and birth. 

Dr. Susan Gennaro and her research team will explicate factors predicting preterm birth in African American women by comparing them with factors predicting preterm birth in Mexican American women. Information about minority women most likely to labor prematurely but deliver at term and those most likely to experience preterm labor and delivery will be obtained in African American women, who are most at risk for early preterm birth, so that targeted interventions can be designed to improve the care of preterm labor and prevent preterm birth.

The aims of this study are to:

  1. Compare the predictive ability of stress, depression, coping, immune function, body mass index, and infection, measured between 22-24 weeks gestation, in identifying African American women who will deliver preterm from those who deliver at term.
    a. Compare predictors of preterm birth at 22-24 weeks gestation in African American women with the same predictors of preterm birth in Mexican American women.
  2. Compare three groups of African American women (1) those women who labor and deliver prematurely, (2) those who labor prematurely but deliver at term, and (3) those who only experience term labor and delivery, to develop a predictive model of pregnancy outcomes in African American women, including a treatment decision tree for prenatal care, which is based on measures of stress, depression, coping, immune function, infection, and health behaviors.
  3. Examine, in African American women, the timing and contribution of mutable factors (stress, depression, coping, infections, smoking, and nutrition) between the onset of preterm labor (or 22-24 weeks of gestation for women who do not experience preterm labor and delivery) to delivery outcome.

The information obtained from this study will provide knowledge about psychosocial, behavioral and physiologic factors that underlie preterm labor and preterm birth and is necessary to develop effective nursing interventions to improve birth outcomes in minority women.

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