title: A review of prenatal home-visiting effectiveness for improving birth outcomes.
abstract: OBJECTIVE
  To determine the effectiveness of prenatal home visiting for improving prenatal care utilization and preventing preterm birth and low birth weight.
  
  
  METHODS
  Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Social Work Abstract databases were searched for articles that examined prenatal home-visiting and prenatal care utilization or neonatal outcomes, with additional ascendancy and descendancy searches. Listservs were also used to identify unpublished evaluations.
  
  
  METHODS
  Quantitative studies meeting the following criteria were included in the analyses: published between 1985 and 2009, published in English, reported providing prenatal home visiting, and reported on prenatal care utilization or a neonatal outcome.
  
  
  METHODS
  Study characteristics and findings related to prenatal care utilization, gestational age, and birth weight were abstracted independently by at least two authors. Study quality was assessed across five domains.
  
  
  RESULTS
  The search yielded 28 studies comparing outcomes for women who did and did not receive prenatal home visiting, with 14 (59%) using an RCT design. Five (17%) studies reporting on prenatal care utilization found a statistically significant improvement in use of prenatal care for women with home visiting. Of 24 studies reporting an effect on birth outcomes, five (21%) found a significant positive effect on gestational age, and seven of 17 (41%) found a significant positive effect on birth weight.
  
  
  CONCLUSIONS
  More evidence suggests that prenatal home visiting may improve the use of prenatal care, whereas less evidence exists that it improves neonatal birth weight or gestational age. These findings have implications for implementing Title II of the Affordable Care Act.
authors.affiliation: School of Public Health, University of Illinois at Chicago, Community Health Sciences Division, Chicago, IL, USA. issel@uic.edu
authors.forename: L Michele
authors.initials: LM
authors.lastname: Issel
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Forrestal
authors.forename: Jaime
authors.initials: J
authors.lastname: Slaughter
authors.forename: Anna
authors.initials: A
authors.lastname: Wiencrot
authors.forename: Arden
authors.initials: A
authors.lastname: Handler
mesh_terms: D000293:Adolescent; D000328:Adult; D019090:Case Management; D003152:Community Health Nursing; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008484:Medicaid; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000706:statistics & numerical data*; D014481:United States