Home-visitation program for first-time teenage mothers shows no benefit compared to usual care
1. First-time teenage mothers randomly assigned to a home-visitation program did not show any short term benefits compared to usual care consisting of primary care and social services.
2. There was no difference in the number of women who smoked at the end of pregnancy or number of second pregnancies within the first 24 months post-partum, as well as similar average birthweights and number of emergency room visits or hospital admissions within the first two years of birth in both groups.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Children of teenage mothers are more likely to have poor long term socioeconomic problems and an early intervention program may help achieve stability in both the mother and child. The Family Nurse Partnership (FNP) is a licensed intensive home-visitation program developed in the USA and introduced into practice in England. Previous trials involving the FNP in the USA reported positive effects and introductory programs in England reported results during pregnancy and the post-partum period in first time mothers up to age 23. This study aimed to assess the effectiveness of the program adapted to the UK health-care model, and applied to teenage first-time mothers, as a randomized controlled trial to compare usual care (primary care and social services) plus FNP to usual care alone.
The addition of the FNP program did not change the number of women who smoked at the end of pregnancy, and resulted in similar numbers in the average birthweight, proportion of children admitted for emergency visits or hospital admissions, as well as the number of women having another pregnancy within 24 months. These findings showed that there was no short-term benefit to the addition of the FNP program for first-time mothers for the primary outcomes. Strengths of this study include having an adequate power to detect effects of the intervention by the second year of birth, while limitations included not distinguishing the causes for emergency room visits or hospital admissions as minor illnesses or more severe illness or injuries.
Click to read the study in The Lancet
In-Depth [randomized controlled trial]: This pragmatic, open-label, individually randomized controlled trial enrolled nulliparous women under age 20 at less than 25 weeks gestation, and able to provide consent and speak English. Women were randomized to either FNP plus usual care (n=823) or usual care alone (n=822). Randomization was stratified by site and minimized by time of gestation (<16 weeks or ≥16 weeks), smoking status, and English-speaking status. The primary outcomes were tobacco use during late pregnancy (34-36 weeks gestation), birthweight, emergency room visits and hospital admissions during the first 24 months of birth, and the proportion of women with a second pregnancy within 24 months post-partum.
The results showed no difference in the percentages of women who smoked at the end of pregnancy, with 304 (56%) of 547 in the FNP group and 306 (56%) of 545 in the usual care group (adjusted odds ratio [AOR] 0.90, 97.5% CI 0.64-1.28). The mean birthweight was similar in both groups, with a mean birthweight of 3,217.4g (SD 618.0) in 742 babies in the FNP group and 3,197.5g (SD 581.5) in 768 babies in the usual care group (adjusted mean difference 20.75g, 97.5% CI -47.73 to 89.23). Both groups also had similar hospital admissions or emergency room visits, with 587 (81%) of 725 children in the FNP group and 577 (77%) of 753 in the usual care group (AOR 1.32, 97.5% CI 0.99-1.76), as well as no difference in the number of pregnancies within 24 months of the first pregnancy (426 [66%] of 643 in the FNP group, 427 [66%] of 646 in the usual care group [AOR 1.01, 0.77-1.33]).
Image: PD
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