Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial.
Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20-<37 weeks gestation; <24 weeks gestation at enrollment; spoke and read English; received care at regional medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62% had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.
Schools of Nursing and Medicine, Vanderbilt University, Nashville, TN, USA, melanie.lutenbacher@vanderbilt.edu.
Melanie
M
Lutenbacher
Patricia Temple
PT
Gabbe
Sharon M
SM
Karp
Mary S
MS
Dietrich
Deborah
D
Narrigan
Lavenia
L
Carpenter
William
W
Walsh
D000328:Adult; D005260:Female; D005865:Gestational Age; D006792:House Calls; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology