Dosage Effect of Prenatal Home Visiting on Pregnancy Outcomes in At-Risk, First-Time Mothers

Abstract

BACKGROUND AND OBJECTIVE: Home visiting programs seek to improve care management for women at high risk for preterm birth (<37 weeks). Our objective was to evaluate the effect of home visiting dosage on preterm birth and small for gestational age (SGA) infants. METHODS: Retrospective cohort study of women in southwest Ohio with a singleton pregnancy enrolled in home visiting before 26 weeks’ gestation. Vital statistics and hospital discharge data were linked with home visiting data from 2007 to 2010 to ascertain birth outcomes. Eligibility for home visiting required ≥1 of 4 risk factors: unmarried, low income, <18 years of age, or suboptimal prenatal care. Logistic regression tested the association of gestational age at enrollment and number of home visits before 26 weeks with preterm birth. Proportional hazards analysis tested the association of total number of home visits with SGA status. RESULTS: Among 441 participants enrolled by 26 weeks, 10.9% delivered preterm; 17.9% of infants were born SGA. Mean gestational age at enrollment was 18.9 weeks; mean number of prenatal home visits was 8.2. In multivariable regression, ≥8 completed visits by 26 weeks compared with ≤3 visits was associated with an odds ratio 0.38 for preterm birth (95% confidence interval: 0.16–0.87), while having ≥12 total home visits compared with ≤3 visits was significantly associated with a hazards ratio 0.32 for SGA (95% confidence interval: 0.15–0.68). CONCLUSIONS: Among at-risk, first time mothers enrolled prenatally in home visiting, higher dosage of intervention is associated with reduced likelihood of adverse pregnancy outcomes.