Does Additional Prenatal Care in the Home Improve Birth Outcomes for Women with a Prior Preterm Delivery? A Randomized Clinical Trial

Abstract

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.

Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial

“…This research builds upon prior studies aimed at decreasing SHS exposure in the home environment. Such studies have typically used one or two HV for pregnant women, 79,80 postpartum women who had recently quit smoking, 81 or children at risk for respiratory diseases 82,83 to attempt to decrease SHS exposure. The present suggests that a larger number of visits over a longer period of time may be useful to encourage smoking abstinence.…”

Eliminating Health Disparities through Action on the Social Determinants of Health: A Systematic Review of Home Visiting in the United States, 2005–2015

“…The prevention categories (Table ) of the research articles included in this section were Maternal/Infant Health ( n = 13), Mental Health ( n = 2), Environment/Safety ( n = 2), Adult Health ( n = 2), and Women's Health ( n = 1). Seven articles in the primary prevention grouping of experimental and quasi‐experimental articles listed a nurse author (Cowell, McNaughton, Ailey, Gross, & Fogg, ; Flynn, Budd, & Modelski, ; Hendrickson, ; Hendrickson, Williams, & Acee, ; Larson, Ferng, McLoughlin, Wang, & Morse, ; Lutenbacher et al., ; Paez et al., ) (Table ).…”

“…The Maternal/Infant Health grouping also contained primary prevention home visiting interventions conducted primarily by nurses (Table ). These included experimental studies designed to enhance parenting behaviors, reduce emergency room visits and hospitalizations (Dodge et al., ), and decrease length of hospital stays after giving birth (Lutenbacher et al., ). A quasi‐experimental study was conducted to improve resource utilization among low‐income pregnant adolescents (Flynn et al., ).…”

Calidad de la relación entre matrones y cuidadores en la visita domiciliaria del Chile Crece Contigo en localidades rurales del Valle de Aconcagua

“…Además, el PADB procura establecer una relación de ayuda entre los matrones y las familias de estos niños. Una de las principales estrategias de intervención para trabajar con las familias es la Visita Domiciliaria (VD) [2][3][4][5][6] .…”

“…Ésta pretende establecer una relación de ayuda 11,12 , ya que permite detectar oportunamente situaciones de riesgo biopsicosocial 13 , además de entregar apoyo instrumental y emocional a las familias [14][15][16] . También ofrece la oportunidad de brindar herramientas a las gestantes, cuidadores u otros integrantes de la familia, de manera que puedan estimular un óptimo crecimiento de los niños/as, permitiéndoles alcanzar un máximo desarrollo de sus potencialidades 5,6,17 . Para cumplir con ésta y otras actividades del programa, existe material desarrollado por el Ministerio de Salud (MINSAL) y el Ministerio de Desarrollo Social, que entregan orientaciones técnicas a los profesionales para que se puedan cumplir las estrategias propuestas 1, 18 .…”