260091 Preventing recurrent preterm births and improving maternal infant health via a home visitation system of care: A randomized clinical trial

Tuesday, October 30, 2012

Melanie Lutenbacher, PhD, MSN, FAAN , Schools of Nursing and Medicine (General Pediatrics), Vanderbilt University, Nashville, TN
Patricia C. Temple Gabbe, MD, MPH , Center for Child and Family Advocacy, Ohio State University and Nationwide Children's Hospital, Columbus, OH
Mary S. Dietrich, PhD , Schools of Nursing and Medicine (Biostatistics & Psychiatry), Vanderbilt Ingram Cancer Center (Biostatistics), Vanderbilt University, Nashville, TN
Sharon M. Karp, PhD, MSN, CPNP , Schools of Nursing and Medicine (General Pediatrics), Vanderbilt University, Nashville, TN
Deborah Narrigan, MSN, CNM , School of Nursing, Vanderbilt University, Nashville, TN
William Walsh, MD , School of Medicine (Neonatology), Vanderbilt University, Nashville, TN
Lavenia Carpenter, MD , School of Medicine (OB-GYN - Maternal-Fetal Medicine), Vanderbilt University, Nashville, TN
Background: High probability of recurrent preterm birth (PTB) with history of prior PTB. Interaction of multiple risk factors and health behaviors may contribute to PTB; some may be amenable to intervention. Home visitation is promising method to deliver evidence based interventions within a system of care (SOC). We evaluated a SOC designed to: 1) reduce preterm births and associated health care costs, and 2) improve the health in pregnant women with a history of a PTB.

Methods: Randomized, parallel-group study in regional medical center. Eligibility: >18 years with prior live birth > 20 - < 37 weeks gestation; < 24 weeks gestation at enrollment; spoke and read English; received care at the 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 collected via multiple methods and sources including intervention fidelity assessments.

Results: 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, however differences between groups included: an increase in gestational age compared to prior PTB, and shorter maternal length of stay at delivery.

Conclusions: Nurse home visits or contact may limit some risk factors and shorten length of stay at delivery. Study contributes to knowledge about evidence-based interventions targeting risk factors associated with PTB.

Learning Areas:
Public health or related nursing
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Describe the strengths and challenges of using home visitation in pregnant women with a history of a preterm birth. 2. Identify selected maternal risk factors amenable to interventions delivered in the home by certified nurse midwives.

Keywords: Home Visiting, Prenatal Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator on multiple projects related to home visitation and maternal-child health. I am particularly interested in the influence of maternal psychosocial risk factors on maternal and child health outcomes. I am the co-PI of the RCT paper under submission.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.