Support during pregnancy for women at increased risk of low birthweight babies

Programs offering additional support during pregnancy were not effective in reducing number of babies born too early and babies with low birthweights.

Babies born to mothers in socially disadvantaged situations are more likely to be small and so have health problems. Programs providing emotional support, practical assistance, and advice have been offered in addition to usual care. The Review of 17 randomized controlled trials, involving 12,264 women, found that women who received additional support during pregnancy were less likely to be admitted to the hospital for pregnancy complications and to have a caesarean birth. However, the additional support did not reduce the likelihood of giving birth too early or that the baby was smaller than expected.

Authors' conclusions: 

Pregnant women need the support of caring family members, friends, and health professionals. While programs which offer additional support during pregnancy are unlikely to prevent the pregnancy from resulting in a low birthweight or preterm baby, they may be helpful in reducing the likelihood of antenatal hospital admission and caesarean birth.

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Background: 

Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programs offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programs may include advice and counseling (about nutrition, rest, stress management, alcohol, and recreational drug use), tangible assistance (e.g., transportation to clinic appointments, household help), and emotional support. The programs may be delivered by multidisciplinary teams of health professionals, specially trained lay workers, or combination of lay and professional workers.

Objectives: 

The primary objective was to assess effects of programs offering additional social support compared with routine care, for pregnant women believed at high risk for giving birth to babies that are either preterm or weigh less than 2500 gm, or both, at birth. Secondary objectives were to determine whether effectiveness of support was mediated by timing of onset (early versus later in pregnancy) or type of provider (healthcare professional or lay woman).

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010).

Selection criteria: 

Randomized trials of additional support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. We defined additional support as some form of emotional support (e.g., counseling, reassurance, sympathetic listening) and information or advice or both, either in home visits or during clinic appointments, and could include tangible assistance (e.g., transportation to clinic appointments, assistance with care of other children at home).

Data collection and analysis: 

Two review authors evaluated methodological quality. We performed double data entry.

Main results: 

We included 17 trials (12,264 women). Programs offering additional social support for at-risk pregnant women were not associated with improvements in any perinatal outcomes, but there was a reduction in the likelihood of antenatal hospital admission (three trials; n = 737; RR 0.79, 95% CI 0.68 to 0.92) and caesarean birth (nine trials; n = 4522; RR 0.87, 95% CI 0.78 to 0.97).

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