Abstract
BackgroundBirth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), are crucial indicators of child development and health.PurposeTo evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes.MethodsIn this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14–19 years old), women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964), which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311) and included in the analysis. Data were analyzed between January and June 2014.ResultsIn the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98) and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92) compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5).ConclusionHome visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.
Highlights
Adverse birth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), can have a long-term impact on child development and health [1,2,3,4,5,6]
We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964), which is a record of prenatal check-ups, delivery, child development and vaccinations
In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth and showed a 0.55-week difference in gestational age compared to the matched controlled sample
Summary
Adverse birth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), can have a long-term impact on child development and health [1,2,3,4,5,6]. Lee and colleagues [36] found that home visits before 30 weeks’ gestation for women (Black and Hispanic: 65%; under 18 years old: 24.6%) were effective for preventing LBW (5.1% versus 9.8%; p = 0.022), McLaughlin and colleagues [37] found home visits for women (Black women: 35%, mean age: 21.8 years old) showed no significant effect in reducing LBW incidence This is likely due to several factors, including differences in the characteristics of target participants and methods of program delivery, the reluctance of high-risk women to participate, and variation in the timing of home-visit implementation between trials [38,39]. An assessment of the effectiveness of home visits for a wide range of high-risk women, and the timing of implementation, is needed Birth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), are crucial indicators of child development and health. To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes
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