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

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.