Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne

Abstract

BackgroundIn the 1980s there was substantial interest in early pregnancy and pre-pregnancy interventions to increase birth weight and reduce preterm birth. We developed an inter-pregnancy intervention, implemented in a randomised controlled trial, to be provided by midwives at home soon after women's first birth.MethodsMCH nurses invited women to take part during their home visit to new mothers. Women's contact details, with their permission, were passed to the study midwife. She had a randomisation schedule to which women's names were added before she met the women or their partners. All women recruited had a home visit from the study midwife with a discussion of their first pregnancy, labour and birth and the postpartum experience. Women in the intervention arm received in addition a pre-pregnancy intervention with discussion of social, health or lifestyle problems, preparation and timing for pregnancy, family history, rubella immunisation, referrals for health problems, and a reminder card. The primary outcome was defined as a birth weight difference in the second birth of 100 g (one-sided) in favour of the intervention. Additional data collected were gestational age, perinatal deaths and birth defects. Analyses used EPI-INFO and STATA.ResultsIntervention and comparison groups were comparable on socioeconomic factors, prior reproductive history and first birth outcomes. Infant birth weight in the second birth was lower (-97.4 g,)) among infants in the intervention arm. There were no significant differences between intervention and comparison arms in the proportion of women having a preterm birth, an infant with low birthweight, or an infant with a birth weight <10th percentile. There were more adverse outcomes in the intervention arm: ten births <32 weeks), compared with one in standard care, and more infants with a birth weight <2000 g, 16 compared with two in standard careConclusionAs the primary outcome was envisaged to be either improved birth weight or no effect, the study was not designed to identify the alternative outcome with confidence. Despite widespread support for pre-pregnancy interventions to improve maternal and perinatal health, this first randomised controlled trial of a multi-component intervention provided at home, did not have a beneficial outcome.

Routine pre-pregnancy health promotion for improving pregnancy outcomes

“…However, in this review we have only been able to include results from four trials (Floyd 2007;Lumley 2006;Robbins 2005;Velott 2008). Two studies did not report findings for the whole sample according to group allocation, but rather for non-random subsets.…”

“…While blinding outcome assessors is possible, participants may disclose group allocation or case notes may reveal it, so blinding may be difficult to achieve in practice. In three of the studies it was not stated whether there was any attempt to blind outcome assessors (Floyd 2007;Lumley 2006;Robbins 2005). In the Pennsylvania study (Velott 2008), it was reported that assessors carrying out physical assessments were blind to group allocation.…”

“…In the study described by Lumley 2006, women recruited to the trial were attending government funded clinics in Australia after the birth of their first child. The intervention was delivered by a specially trained pre-pregnancy midwife and involved a home visit where risks were identified, with hospital referral for any risk factors identified, and advice on lifestyle factors related to poor pregnancy outcomes (e.g.…”

“…by attempting to include all participants randomised to each group in the analyses, with the denominator for each outcome in each trial being the number randomised minus any participants known to be missing. For one trial included in the review (Lumley 2006), outcome data were reported only for that subset of the sample that became pregnant and were not otherwise lost to follow up during the study period (pregnancy outcome data were available for only half of the sample randomised). For pregnancy outcomes, we have presented results for this subset that remained available to follow up and that became pregnant (and were therefore eligible for pregnancy outcomes), but recognise that this is a potentially serious source of bias.…”

An Integrative Review of Home Care Service for Pregnant Women, Mothers, Infants, and Toddlers in Vulnerable Group

“…Parenting attitude [21] Responsibility [21] Parent's sense of competence [21] Social competence [18,19] N/A Providing pre-pregnancy information [14,[18][19][20]22] Casaerean section rate [22] Rate of spontaneous onset of labour [22] Apgar scores [22] Birth weight [22] Gestational age [22] Prematurity [22] Information about maternal self-care (e.g. Nutrition, physical activity) [18,19] N/A N/A Modifying behaviors [18,19] Smoking behavior [18,19] Caregiver self-sufficiency [23] Episodes of malaria treated at community level [24] Symptom severity of asthma [23] Emergency department visit [23] Safety management [16,18,19] N/A HOME score [16] Intense home visit by developmental milestone Infant and toddlers Providing information of child nutrition and physical activity by developmental milestone [25,26] Infant weight gain [25] Introduction of solids [25] BMI [25] Eating habits (TV viewing time) [25] Intake of fruit and vegetables [25] Physical activity [25] Frequency of eating [25] processed meat [25] No continuous effect on BMI, physical activity, eating habit (3 years after intervention) [26]...…”