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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  • 作者:Melanie Lutenbacher (1)
    Patricia Temple Gabbe (2)
    Sharon M. Karp (1)
    Mary S. Dietrich (3)
    Deborah Narrigan (4)
    Lavenia Carpenter (5)
    William Walsh (6)
  • 关键词:Preterm birth ; Home visitation ; Prenatal care ; System of care
  • 刊名:Maternal and Child Health Journal
  • 出版年:2014
  • 出版时间:July 2014
  • 年:2014
  • 卷:18
  • 期:5
  • 页码:1142-1154
  • 全文大小:
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  • 作者单位:Melanie Lutenbacher (1)
    Patricia Temple Gabbe (2)
    Sharon M. Karp (1)
    Mary S. Dietrich (3)
    Deborah Narrigan (4)
    Lavenia Carpenter (5)
    William Walsh (6)

    1. Schools of Nursing and Medicine, Vanderbilt University, Nashville, TN, USA
    2. College of Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, OH, USA
    3. Department of Biostatistics, Schools of Medicine and Nursing, Vanderbilt University, Nashville, TN, USA
    4. School of Nursing, Vanderbilt University, Nashville, TN, USA
    5. Division of Maternal-Fetal Medicine, Vanderbilt University, Nashville, TN, USA
    6. Division of Neonatology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
  • ISSN:1573-6628
文摘
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 ?0-lt;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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