Home visits during pregnancy and after birth for women with an alcohol or drug problem
Abstract
Background
One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits.
Objectives
To determine the effects of home visits during pregnancy and/or after birth for pregnant women with a drug or alcohol problem.
Search methods
We searched the Cochrane Pregnancy and Childbirth Trials Register (30 April 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to April 2004), EMBASE (1980 to week 16, 2004), CINAHL (1982 to April 2004), PsycINFO (1974 to April 2004), citations from previous reviews and trials, and contacted expert informants.
Selection criteria
Studies using random or quasi‐random allocation of pregnant or postpartum women with a drug or alcohol problem to home visits. Trials enrolling high‐risk women of whom more than 50% were reported to use drugs or alcohol were also eligible.
Data collection and analysis
Assessments of trials were performed independently by all review authors. Statistical analyses were performed using fixed and random‐effects models where appropriate.
Main results
Six studies (709 women) compared home visits after birth with no home visits. None provided a significant antenatal component of home visits. The visitors included community health nurses, pediatric nurses, trained counsellors, paraprofessional advocates, midwives and lay African‐American women. Most studies had methodological limitations, particularly large losses to follow up. There were no significant differences in continued illicit drug use (2 studies, 248 women; relative risk (RR) 0.95, 95% confidence interval (CI) 0.75 to 1.20), continued alcohol use (RR 1.08, 95% CI 0.83 to 1.41) failure to enrol in a drug treatment program (2 studies, 211 women; RR 0.45 95% CI 0.10 to 1.94). There was no significant difference in the Bayley MDI (3 studies, 199 infants; weighted mean difference 2.89, 95% CI ‐1.17 to 6.95) or Psychomotor Index (WMD 3.14, 95% CI ‐0.03 to 6.32). Other outcomes reported by one study only included breastfeeding at six months (RR 1.00, 95% CI 0.81 to 1.23), incomplete six‐month infant vaccination schedule (RR 1.07, 95% CI 0.58 to 1.96), non‐accidental injury and non‐voluntary foster care (RR 0.16, 95% CI 0.02 to 1.23), failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82), child behavioural problems (RR 0.46, 95% CI 0.21 to 1.01), and involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74).
Authors' conclusions
There is insufficient evidence to recommend the routine use of home visits for women with a drug or alcohol problem. Further large, high‐quality trials are needed, and women's views on home visiting need to be assessed.
PICOs
Plain language summary
Home visits during pregnancy and after birth for women with an alcohol or drug problem
Not enough information on home visiting in pregnancy and after the birth for women with an alcohol or drug problem.
Women with an alcohol or drug problem in pregnancy are at increased risk of miscarriage, low birthweight babies, infections and postnatal depression, and the babies of withdrawal symptoms or impaired development. Home visits by individuals or teams of health professionals or trained lay people are aimed at improving health and social outcomes for mothers and babies. A review of trials found evidence that home visits after the birth increased the engagement of these women in drug treatment services but there were insufficient data to say if this improved the health of the baby or mother. Further research is needed, with visits starting during pregnancy.
