Reducing Low Birth Weight Through Home Visitation: A Randomized Controlled Trial

The risk of preterm and low birth weight (LBW) babies is increased in pregnant women who are young, black, and poor, or who have other socioeconomic disadvantages. Early mortality, health problems, and developmental delays are more likely in such babies than in full-term babies. In several studies, improved birth outcomes were achieved with programs providing teenage or low-income mothers access to services and case management. Home visitation is one such program that reduced the frequency of LBW in 2 randomized controlled trials. This study assessed the effectiveness of a prenatal home-visitation program, Healthy Families New York (HFNY), in reducing the incidence of LBW deliveries and other adverse outcomes in socially disadvantaged pregnant women and adolescents. This study was part of a larger randomized controlled trial. Expectant and new mothers eligible for HFNY at 3 sites were randomly assigned to an intervention group (n = 236) or a control group (n = 265). The intervention group was offered biweekly HFNY home-visits, which focused on providing prenatal social support, health education, and linking the mother to medical and other community services. The control group received information and referrals to services other than home visitation. Eligibility criteria were based on socioeconomic factors such as poverty, teen pregnancy, not being married, and the risk of child maltreatment. Nearly half of the participants were black and about one-fourth were Hispanic; 90% were unmarried. The gestational age at randomization was ≤30 weeks. To determine whether enrollment at an earlier gestational age would improve outcomes, subgroup analyses were conducted by gestational age at randomization of ≤24 weeks or ≤16 weeks. The primary study outcome was a delivery weight of <2500 g. Mothers in the intervention group randomized at a gestational age of ≤30 weeks were significantly less likely than those in the control group to have LBW babies (5.1% vs. 9.8%). The adjusted odds ratio was 0.43, with a 95% confidence interval of 0.21 to 0.89. Enrollment in the HFNY program at a gestational age of ≤24 weeks reduced the odds for LBW even further (adjusted odds ratio, 0.32; 95% confidence interval, 0.14―0.74). The investigators conclude from these findings that a prenatal home visitation program providing social support and other enhanced, multifaceted services holds great promise to reduce LBW deliveries among socially disadvantaged at-risk pregnant women.