Table 1.
Summary of RCTs addressing effects of enhanced care compared with usual care on preterm birth rates
| Preterm delivery before 37 weeks' gestation | ||||
| Ref | Nature of intervention* | Intervention group | Control group† | Results |
| 1 or 2 home visits/week by lay workers with no formal training in a client-led role; from booking in before 20 weeks' gestation until birth | 6/60 (10%) | 5/54 (9%) | P >0.05 | |
| 1 home visit/week by trained nurses for cervical examination, education about preterm labour symptoms and signs; from 20 to 37 weeks' gestation | 143/1024 (14%) | 168/1197 (14%) | P >0.05 | |
| 1 clinic visit/week with trained nurses for cervical examination, education about preterm labour symptoms and signs; from 22 weeks' gestation until birth | 78/491 (16%) | 68/478 (14%) | P >0.05 | |
| 1 home visit every 1 or 2 weeks by trained midwife plus access to domiciliary midwives by telephone for measurement of blood pressure, urinary glucose and protein levels, cervical examination, monitoring of fundal height, fetal heart rate, and movements; from 26 weeks' gestation until birth | 12/79 (15%) | 13/73 (18%) | P >0.05 | |
| 4 home visits at around 22, 26, 30, and 34 weeks' gestation with 2 more optional at discretion of woman and study staff by trained social workers or obstetric nurses. Additional access to special support office at any time in person or by telephone. Aiming to strengthen social network, providing strategies to address worries, health education including nutrition, smoking, alcohol, and drug use. Assessed at 36 weeks' gestation and 40 weeks' postpartum | 123/1115 (11%) | 140/1120 (13%) | OR 0.88, 95% CI 0.67 to 1.16 | |
| 1 home visit/week by trained nurse for routine obstetric care and education about preterm labour symptoms and signs from 20 to 24 weeks' gestation until birth. All people identified as low income | 192/1200 (16.0%) | 185/1195 (15.5%) | P >0.05 | |
| 1 telephone call/week by trained nurse assessing health status, recommendations from this, and discussion of any other issues concerning the mother; from time of home visit at 22 to 32 weeks' gestation until 37th week | 72/718 (10%) | 79/715 (11%) | RR 0.87, 95% CI 0.62 to 1.22; P = 0.42 | |
| 1 home visit every 2 weeks by trained nurses for parent health education and awareness of preterm labour symptoms and signs, enhancement of informal support systems, and linkage of parents with community services. Each mother had an average of 9 visits | 12/166 (7%) | 10/142 (7%) | P >0.05 | |
| 17 home visits from first or second trimester to end of first year of birth (1–2 antenatal visits), for preparation for motherhood classes during third trimester | 2/62 (3%) | 5/59 (9%) | Not significant; P value not reported | |
| 1 home visit every 1 to 2 weeks by trained midwives for gentle cervical examination and recommendations to decrease physical activity if necessary; from booking in until birth | 107/667 (16%) | 122/679 (18%) | P >0.05 | |
| 1 clinic visit every 2 weeks with trained nurses for educationally orientated peer groups, strengthening of social support, smoking-cessation programmes as necessary, discussion of problems, health education, and additional appointments as needed, and extended time with clinicians from before 26 weeks' gestation until birth | 33/318 (10%) | 42/301 (14%) | P = 0.22 | |
This table shows the results from year 1 (of 3). No significant difference seen over whole length of study compared with control group. *The definition of high risk varied between RCTs. †Antenatal care in outpatient clinic.