Does Additional Prenatal Care in the Home Improve Birth Outcomes for Women with a Prior Preterm Delivery? A Randomized Clinical Trial




Melanie Lutenbacher, Patricia Temple Gabbe, Sharon M. Karp, Mary S. Dietrich, Deborah Narrigan, Lavenia Carpenter, and William Walsh

Brief Type

Journal publication



Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20–<37 weeks gestation; <24 weeks gestation at enrollment; spoke and read English; received care at regional medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62 % had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB. (author abstract)

Data Collection Methods

  • Fidelity observations
  • Interviews
  • Program administrative record reviews



For More Information

Lutenbacher, M., Gabbe, P. T., Karp, S. M., Dietrich, M. S., Narrigan, D., Carpenter, L., & Walsh, W. (2014). Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial. Maternal and Child Health Journal, 18(5), 1142-1154.
Author Contact Information:
Melanie Lutenbacher


  • Participant Characteristics
  • Participant, Family, and Program Outcomes