Home based educational intervention to improve perinatal outcomes for a disadvantaged community: a randomised control trial.

Objectives: Pregnancy, labour, and delivery involve risk for mothers and infants. This study tested the effectiveness of a home-based programme to improve perinatal outcomes among socially disadvantaged women. The hypothesis was that the intervention group who received education and support during pregnancy would have better perinatal outcomes than the control group.
Study Design: This is a randomised controlled trial. Pregnant women from a disadvantaged community in Dublin, Ireland were eligible for participation in Preparing for Life, a home visiting early intervention programme. 233 participants were recruited and assigned to an intervention (n=115) and control (n=118) group using an unconditional probability randomisation strategy. Maternity hospital records were available for 206 participants (nintervention=106; ncontrol=100). Consent to access records was not provided by 9 participants, records were missing for 17 participants and 1 record was excluded due to miscarriage. The intervention group were prescribed an average of ten prenatal home visits from a trained mentor. Mentors provided information on healthy prenatal behaviours and the birthing experience using tip sheets and social support. The control group received care as usual including the opportunity to attend standard antenatal classes. The outcomes included neonatal (Apgar scores, birth weight, gestational age and prematurity) and maternal (labour onset method and delivery method) outcomes. Statistical analyses were conducted using t -tests, tests of proportions, regression, logistic regression and permutation testing.
Results: There were no differences on any of the neonatal outcomes or the majority of the maternal outcomes. Two secondary results were found such that there was an increase in the rate of spontaneous onset of labour in the intervention group compared to the control group (69.8% v 58.0%; OR 1.67, 95% CI=0.94, 2.97; p<0.05) and there was a reduction in caesarean section rates in the intervention group compared to the control group (15.1% v 25.0%; OR 0.53, 95% CI=0.27, 1.07; p<0.05).
Conclusions: This prenatal home visiting programme had no impact on neonatal outcomes, yet there was suggestive evidence that it prepared women for birth, and potentially led to increased spontaneous onset of labour and reduced caesarean section. Further studies are required to test these observation generating hypotheses. Trial registration ISRCTN04631728- http://www.controlled-trials.com/ISRCTN04631728/
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