A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents

Abstract

To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child’s age of 24 months. Participants were assessed by blind interviewers at 8–16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child’s age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen’s d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).

Social communication therapy for children at risk for neurodevelopmental difficulties: Protocol for a clinical trial

“…Another difference between PACT and other early interventions [23][24][25] that have been used in LMICs is the use of video feedback, which promotes and facilitates parental learning of intervention strategies. 11,12,[15][16][17][18][19] If the results of the current trial indicate positive effects of PACT on child development, the use of video-feedback could be considered for incorporation in other early intervention programs.…”

“…Large‐scale longitudinal studies have confirmed that impairments in motor, cognitive, and social communication development related to socioeconomic disadvantage, lack of stimulation and learning opportunities and challenging family environments are common among young children in Brazil 20–22 . Despite the global promotion of the importance of early interventions for vulnerable children in these settings, 23,24 few early interventions have been tested for at‐risk young children in Brazil 25 and those programs did not focus on social communication abilities specifically nor use techniques, such as video‐feedback, to enhance the attainment of intervention targets.…”

Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life

“…In the current report, we conducted analyses on the entire sample (n=80) of adolescent mothers while adjusting for group; the effects of the intervention are reported elsewhere. 51 , 52 The sample’s characteristics are shown in Table 1 . The mean age at baseline was 17.1 years (standard deviation [SD] = 1.2).…”

“…Depression symptoms were assessed with the Brazilian Portuguese version of the Beck Depression Inventory, 49 - 51 a 21-item scale that assesses the presence and severity of depression symptoms in the last 2 weeks. Scores range from 0-63, with higher scores indicating more severe depression symptoms.…”

Comparação de redes de microRNAs placentários de primigestas submetidas a intervenção psicossocial

“…Dentre essas, foi evidenciado uma menor aceleração da idade metilômica no grupo intervenção comparado ao não intervenção e também a metilação do DNA em diferentes regiões mediou a associação entre intervenção e uma resposta cognitiva(Euclydes et al, 2022). Outro estudo revelou um efeito positivo da intervenção no desenvolvimento da expressão de linguagem nas crianças, na responsividade emocional/verbal das mães e oportunidades para variedades na estimulação diária(Fatori D et al 2021). E um outro estudo que avaliou a prole, constatou que crianças com 12 meses do grupo intervenção estavam mais apegadas e envolvidas com suas mães quando comparadas ao grupo controle(Alarcão et al, 2021).Dweep, H et al miRWalk2.0: a comprehensive atlas of microRNA-target interactions, Nature Methods, 12(8): 697-697 (2015).…”