The impact of nurse case management home visitation on birth outcomes in African-American women.
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of the Navy, Department of Defense or the U. S. government. Dr. Wells is a military service member (employee of the U.S. government). This work was prepared as a part of her official duties. Title 17, USC Section 101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. government as part of the person's official duties. Despite substantial reductions in U.S. infant mortality rates, racial disparities persist, with black Americans experiencing 2.4 times the rate of their white counterparts. Low birthweight and preterm delivery contribute to this disparity.


METHODS
To examine the association between antepartum nurse case management home visitation and the occurrence of low birthweight and preterm deliveries in African-American women in Montgomery County, MD, a retrospective cohort study was conducted using existing data from 109 mothers who were enrolled in the Black Babies Start More Infants Living Equally Healthy (SMILE) program. Logistic regression analysis was used.


RESULTS
Women who received antepartum home visits were 0.37 (CI 0.15-0.94) times less likely to experience preterm delivery than women who did not receive antepartum home visits. The effect of antepartum home visits on preterm delivery was independent of level of prenatal care, negative life events and number of prior live births. There was no significant association between antepartum home visits and low birthweight.


CONCLUSIONS
Antepartum home visits appeared to be protective against preterm delivery and could contribute to reducing racial disparities in infant mortality. Further study is needed to understand and replicate specific program components that may contribute to improved birth outcomes in African-American women.
Department of Preventive Medicine and Biometrics , Uniformed Services University of the Health Sciences, Bethesda, MD, USA. natalie.wells@med.navy.mil
Natalie
N
Wells
Tracy
T
Sbrocco
Chiao-Wen
CW
Hsiao
Lauren D
LD
Hill
Nicole A
NA
Vaughn
Brenda
B
Lockley
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D019090:Case Management; D005260:Female; D006792:House Calls; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D009732:Nursing Care / Q000379:methods*; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016730:Program Development; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors