title: Effects of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: a randomized controlled trial.
abstract: OBJECTIVE
  antenatal smoking is more prevalent among young women with low socio-economic status. The aim of our study is to assess whether the VoorZorg programme, compared to usual care, is effective in reducing cigarette smoking among young high risk pregnant women. Furthermore, the effect of VoorZorg on pregnancy outcomes and on breast feeding will be described.
  
  
  METHODS
  a randomised controlled trial of VoorZorg, a nurse home visitation intervention, was undertaken over a 2½ year period from 2007 to 2009. Data were collected between 16 and 28 weeks gestation, 32 weeks gestation and at two months post partum on cigarette smoking status plus six months post partum for breastfeeding prevalence. Neonatal birth weight and gestation at birth were also collected.
  
  
  METHODS
  participants living in 20 municipalities in the Netherlands.
  
  
  METHODS
  460 pregnant women were recruited by different professionals. Inclusion criteria were age <26 years, ≤28 weeks pregnancy with the first child, low educational level and some knowledge of the Dutch language.
  
  
  METHODS
  women in the intervention group received, in addition to usual care, the VoorZorg programme which consisted of 40-60 home visits by specialised nurses from pregnancy until two years after birth.
  
  
  RESULTS
  the percentage of smokers was significantly lower in the intervention group (40%) compared to the control group (48%) during pregnancy (p=0.03) and at two months post birth (49% and 62%; p=0.02). During pregnancy the number of daily cigarettes smoked was reduced in both groups. After birth, the intervention group smoked 50% less cigarettes compared to the control group (C: 8±10; I: 4±7 (mean±standard deviation (SD)), p=0.01). Furthermore, women in the intervention group did not smoke near the baby (C: 2±5; I: 0±0 (mean±SD) p=0.03). Birth weight and gestational age were similar in both groups (C: 3147g, 40 weeks; I: 3144g, 39 weeks (p=0.94, p=0.17)). Significantly more women in the intervention group were still breast feeding their baby at six months post -birth (C: 6%; I: 13%, p=0.04).
  
  
  CONCLUSIONS
  VoorZorg seemed to be effective in reducing cigarette smoking and in increasing breastfeeding duration. No effect was found on pregnancy outcomes.
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Center, Department of Public and Occupational Health, Van Der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: j.mejdoubi@vumc.nl.
authors.forename: Jamila
authors.initials: J
authors.lastname: Mejdoubi
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Center, Department of Public and Occupational Health, Van Der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: s.vandenheijkant@vumc.nl.
authors.forename: Silvia C C M
authors.initials: SC
authors.lastname: van den Heijkant
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Center, Department of Public and Occupational Health, Van Der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: f.v.leerdam@igz.nl.
authors.forename: Frank J M
authors.initials: FJ
authors.lastname: van Leerdam
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands. Electronic address: m.r.crone@lumc.nl.
authors.forename: Matty
authors.initials: M
authors.lastname: Crone
authors.affiliation: de Waag, Center for Forensic Services, Amsterdam, the Netherlands. Electronic address: crijnen@xs4all.nl.
authors.forename: Alfons
authors.initials: A
authors.lastname: Crijnen
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Center, Department of Public and Occupational Health, Van Der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: ra.hirasing@vumc.nl.
authors.forename: Remy A
authors.initials: RA
authors.lastname: HiraSing
mesh_terms: D001942:Breast Feeding; D005260:Female; D006792:House Calls; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008880:Midwifery; D009426:Netherlands; D010353:Patient Education as Topic; D011247:Pregnancy; D011264:Pregnancy Trimesters; D037841:Pregnant People / Q000523:psychology*; D016037:Single-Blind Method; D016540:Smoking Cessation; D012944:Social Support; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breastfeeding; High-risk; Pregnancy outcome; Smoking cessation