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

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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.

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Acknowledgments

Support for this work was provided by a Grant from the BlueCross BlueShield Tennessee Health Foundation and by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We thank Shari Barkin, M.D., M.S.H.S, and Dawn Misra, Ph.D. for their critical reviews.

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Authors and Affiliations

  1. Schools of Nursing and Medicine, Vanderbilt University, Nashville, TN, USA

    Melanie Lutenbacher & Sharon M. Karp

  2. College of Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, OH, USA

    Patricia Temple Gabbe

  3. Department of Biostatistics, Schools of Medicine and Nursing, Vanderbilt University, Nashville, TN, USA

    Mary S. Dietrich

  4. School of Nursing, Vanderbilt University, Nashville, TN, USA

    Deborah Narrigan

  5. Division of Maternal-Fetal Medicine, Vanderbilt University, Nashville, TN, USA

    Lavenia Carpenter

  6. Division of Neonatology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    William Walsh

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  1. Melanie Lutenbacher
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Correspondence to Melanie Lutenbacher.

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Lutenbacher, M., Gabbe, P.T., Karp, S.M. et al. Does Additional Prenatal Care in the Home Improve Birth Outcomes for Women with a Prior Preterm Delivery? A Randomized Clinical Trial. Matern Child Health J 18, 1142–1154 (2014). https://doi.org/10.1007/s10995-013-1344-4

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