Support during pregnancy for women at risk for low birthweight babies

Programs that provide additional social support during pregnancy for women at increased risk of low birthweight babies are unlikely to have much of an impact on the prevalence of low birthweight infants or preterm births, according to a 2019 review in the Cochrane Database of Systematic Reviews.

These programs, which may include emotional support, tangible/instrumental support (in the form of direct assistance/home visits) and informational support (through advice, guidance and counseling), are delivered by multidisciplinary teams of health professionals, specially trained lay workers or a combination of both,

The review found that such programs have negligible influence on stillbirth or neonatal death. However, such programs may help to reduce the chances of cesarean birth and antenatal hospital admission.

“Low birthweight babies, whether born prematurely or simply smaller than average at full term, often have additional needs,” said lead author Christine East, PhD, professor of nursing and midwifery at La Trobe University in Melbourne, Australia. “Prevention of low birthweight may be possible in some circumstances.”

The authors searched the Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), along with reference lists of retrieved studies, in February 2018.A total of 25 studies were included in the updated review, with outcome data from 21 studies consisted of 11,246 mothers and babies

Compared to routine care, programs offering additional social support for at‐risk pregnant women did not significantly reduce the number of babies born with a birthweight less than 2500 g (127 per 1,000 vs. 120 per 1,000) (risk ratio [RR] 0.94; 95% confidence interval (CI): 0.86 to 1.04).  The number of preterm births was also not significantly different between groups (128 per 1,000 vs. 117 per 1,000) (RR 0.92; 95% CI: 0.84 to 1.01). Further, there was no difference between interventions for stillbirth/neonatal death (RR 1.11; 95% CI: 0.88 to 1.41).

On the other hand, there was a significant reduction in rate of cesarean delivery from 215 per 1,000 to 194 per 1,000 (RR 0.90; 95% CI: 0.83 to 0.97) in groups that received additional social support compared to those that did not. In addition, a reduction was seen in the number of antenatal hospital admissions per participant (RR 0.78; 95% CI: 0.68 to 0.91).

 “Health services and their consumers need to co-design systems that enable better prepregnancy and pregnancy health in order to promote the best possible outcomes for mothers and their babies,” Dr. East told Contemporary OB/GYN.

Disclosures:

Dr. East reports no relevant financial disclosures.