The association of maternal alcohol use and paraprofessional home visiting with children’s health: A randomized controlled trial.

Abstract

This study examines the effect of a home visiting intervention on maternal alcohol use, problematic drinking, and the association of home visiting and alcohol use on children's behavioral, cognitive, and health outcomes at 5 time points over 5 years. Method: We analyzed 5,099 observations of 1,236 mothers and their children from pregnancy to 5 years postbirth, within a longitudinal clusterrandomized trial evaluating the effect of a home visiting intervention on mothers in Cape Town, South Africa. Paraprofessional home visitors coached mothers on coping with multiple risk factors, including a brief, 1-visit intervention on alcohol prevention in pregnancy. We assessed changes in maternal drinking over time in relation to the intervention, and then examined the impact of these drinking patterns on child outcomes over five years. Results: Drinking increased over the 5 years postbirth, but it was significantly lower in the intervention condition. Compared with abstinence, mothers' problematic drinking was associated with decreased child weight (Ϫ0.21 z-units) at all assessments, increased child aggressive behavior (3 to 7 additional symptoms), and decreased child performance on an executive functioning measure (the silly sounds task; odds ratio ϭ .34) at 3 and 5 years. The intervention's effect was associated with increased child aggression (0.25 to 0.75 of 1 additional symptom), but the intervention appeared to decrease the effect of problem drinking on children's aggressive acts and executive functioning. Conclusion: These findings support the need for sustained interventions to reduce alcohol use, especially for mothers who exhibit problematic drinking. Maternal drinking influences children's health and development over time. What is the public health significance of this article?This study highlights the need for home visiting programs that address maternal drinking during pregnancy and early childhood. Even brief alcohol interventions, nested within a generalist home visiting intervention, result in less problematic drinking over the next 5 years. The findings demonstrate that problematic alcohol use is associated with children's increased challenge to maintain healthy growth, inhibitory control, and nonaggressive behavior overtime.

Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

“…Population: most trials were conducted in upper-middle-income countries (Brazil, Chile, China, Iran, Lebanon, Malaysia, Mexico and South Africa) (Langer et al, 1998;Bastani et al, 2006;Aracena et al, 2009;Carvalho et al, 2009;Cooper et al, 2009;Le Roux et al, 2013;Le Roux et al, 2014; Rotheram-Borus et al, 2014a; Rotheram-Borus et al, 2014b; Tomlinson, 2014; Karamoozian and Askarizadeh, 2015;Murray et al, 2015;Tomlinson et al, 2015;Tomlinson et al, 2016b;Tomlinson et al, 2016a;Zhao et al, 2017, Rotheram-Fuller et al, 2018Mohd Shukri et al, 2019;Nabulsi et al, 2019;Rotheram-Borus et al, 2019;Guo et al, 2020;Zhao et al, 2020) followed by lower-middle-income (India, Nigeria and Pakistan) (Rahman et al, 2008;Tripathy et al, 2010;Maselko et al, 2015;Dabas et al, 2019;Fuhr et al, 2019;Gureje et al, 2019;Sikander et al, 2019;Rajeswari and SanjeevaReddy, 2020), low-income (Pakistan) (Rahman et al, 2008;Maselko et al, 2015) and a multi-site trial of lower-middle (Cuba) and upper-middle-income countries (Argentina, Brazil and Mexico) (Villar et al, 1992) (Table 1). Most trials enrolled pregnant women in their second and/or third trimester (Villar et al, 1992; Epidemiology and Psychiatric Sciences Langer et al, 1998;Bastani et al, 2006;Rahman et al, 2008;Aracena et al, 2009;Co...…”

“…Most trials enrolled pregnant women in their second and/or third trimester (Villar et al, 1992; Epidemiology and Psychiatric Sciences Langer et al, 1998;Bastani et al, 2006;Rahman et al, 2008;Aracena et al, 2009;Cooper et al, 2009;Le Roux et al, 2013;Le Roux et al, 2014;Tomlinson, 2014;Rotheram-Borus et al, 2014a;Rotheram-Borus et al, 2014b;Maselko et al, 2015;Murray et al, 2015;Tomlinson et al, 2015;Tomlinson et al, 2016a;Tomlinson et al, 2016b;Fuhr et al, 2019;Gureje et al, 2019;Kola et al, 2019;Mohd Shukri et al, 2019;Oladeji et al, 2019;Sikander et al, 2019;Guo et al, 2020;Rajeswari and SanjeevaReddy, 2020;Zhao et al, 2020). Four trials enrolled women that had recently given birth (Carvalho et al, 2009;Tripathy et al, 2010;Le Roux et al, 2013;Le Roux et al, 2014;Rotheram-Borus et al, 2014b;Tomlinson, 2014;Tomlinson et al, 2015;Tomlinson et al, 2016a;Tomlinson et al, 2016b, Rotheram-Fuller et al, 2018Dabas et al, 2019;Rotheram-Borus et al, 2019). Some trials enrolled specific subgroups of pregnant women including adolescents or young adults (Aracena et al, 2009), low-income (Cooper et al, 200...…”

“…Interventions (Table 2): nine trials delivered the intervention through home visits provided by health educators (Aracena et al, 2009), peers (Fuhr et al, 2019;Sikander et al, 2019), nurses (Villar et al, 1992), certified lactation consultants (Nabulsi et al, 2019), community health workers (Rahman et al, 2008;Cooper et al, 2009;Le Roux et al, 2013;Rotheram-Borus et al, 2014b;Tomlinson, 2014;Maselko et al, 2015;Murray et al, 2015;Tomlinson et al, 2015;Le Roux et al, 2014;Tomlinson et al, 2016a;Tomlinson et al, 2016b;Rotheram-Borus et al, 2019, Rotheram-Fuller et al, 2018, social workers (Villar et al, 1992) or a researcher (Mohd Shukri et al, 2019). Twelve trials delivered the intervention in hospital-or clinicbased settings by nurse researchers (Bastani et al, 2006), primary maternal care providers (Gureje et al, 2019), psychologists (Carvalho et al, 2009), doulas/midwives/lactation consultants (Langer et al, 1998;Nabulsi et al, 2019;Zhao et al, 2020), peers (Rotheram-Borus et al, 2014a;Fuhr et al, 2019;Sikander et al, 2019) or research staff (Zhao et al, 2017;Dabas et al, 2019;Mohd Shukri et al, 2019;Rajeswari and SanjeevaReddy, 2020).…”

“…MMH components included education surrounding selfesteem and/or problem-solving (Aracena et al, 2009;Tripathy et al, 2010;Le Roux et al, 2013;Le Roux et al, 2014;Tomlinson, 2014;Rotheram-Borus et al, 2014b;Tomlinson et al, 2015;Tomlinson et al, 2016a;Tomlinson et al, 2016b;Gureje et al, 2019;Oladeji et al, 2019), strengthening social networks (Rotheram-Borus et al, 2014a, Rotheram-Fuller et al, 2018Nabulsi et al, 2019;Rotheram-Borus et al, 2019), provision of social, psychological and emotional support (Villar et al, 1992;Cooper et al, 2009;Tripathy et al, 2010;Murray et al, 2015;Nabulsi et al, 2019), cognitive-behavioural strategies (Le Roux et al, 2013;Le Roux et al, 2014;Rotheram-Borus et al, 2014a;Rotheram-Borus et al, 2014b;Tomlinson, 2014;Tomlinson et al, 2015;Karamoozian and Askarizadeh, 2015;Tomlinson et al, 2016a;Tomlinson et al, 2016b, Rotheram-Fuller et al, 2018Fuhr et al, 2019;Rotheram-Borus et al, 2019;Sikander et al, 2019), alcohol use prevention (Le Roux et al, 2013;Rotheram-Borus et al, 2014b;Tomlinson, 2014;Rotheram-Borus et al, 2014a;Tomlinson et al, 2015…”

“…Growth indicators: the earliest growth indicator, low birth weight, was reported in four publications representing three trials. Findings were inconclusive as one trial reported a lower prevalence of low birth weight in infants of mothers in the intervention v. control (Bastani et al, 2006), while others found marginal (Le Roux et al, 2013;Rotheram-Borus et al, 2014b) or no difference in the prevalence of low birth weight between groups (Villar et al, 1992) (online Supplementary File 2). Standardised measures of weight-for-age and height-for-age were evaluated in five trials.…”