Reducing low birth weight through home visitation: a randomized controlled trial

Abstract

Background: Poor birth outcomes increase the risk of infant mortality and morbidity, developmental delays, and child maltreatment. This study assessed the effectiveness of a prenatal home-visitation program in reducing adverse birth outcomes among socially disadvantaged pregnant women and adolescents.

Design: As part of a larger RCT, this study examined the effects of home-visitation services on low birth weight (LBW) deliveries.

Setting/participants: Pregnant women and adolescents eligible for Healthy Families New York (HFNY) were recruited in three communities. Eligibility was based on socioeconomic factors such as poverty, teen pregnancy, and the risk of child maltreatment. Two thirds of the participants were black or Hispanic, and 90% were unmarried.

Intervention: Pregnant women and adolescents were randomized to either an intervention group that received bi-weekly home-visitation services (n=236) or to a control group (n=265). Home visitors encouraged healthy prenatal behavior, offered social support, and provided a linkage to medical and other community services. Services were tailored to individual needs.

Main outcome measure: An LBW of <2500 grams on birth certificate files. Baseline and birth interviews were conducted from 2000 to 2002, and birth records were collected in 2007. Analyses were done from 2007 to 2008.

Results: The risk of delivering an LBW baby was significantly lower for the HFNY group (5.1%) than for the control group (9.8%; AOR=0.43; 95% CI=0.21, 0.89). The risk was further reduced for mothers who were exposed to HFNY at a gestational age of <or=24 weeks (AOR=0.32; 95% CI=0.14, 0.74).

Conclusions: A prenatal home-visitation program with focus on social support, health education, and access to services holds promise for reducing LBW deliveries among at-risk women and adolescents.