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Lay support for pregnant women with social risk: a randomised controlled trial
  1. Sara Kenyon1,
  2. Kate Jolly1,
  3. Karla Hemming1,
  4. Lucy Hope2,
  5. Jackie Blissett3,
  6. Sophie-Anna Dann1,
  7. Richard Lilford4,
  8. Christine MacArthur1
  1. 1Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
  2. 2University of Worcester
  3. 3School of Psychology, University of Birmingham, Birmingham, UK
  4. 4Department of Population Evidence & Technologies, University of Warwick, Warwick Medical School, Coventry, UK
  1. Correspondence to Sara Kenyon; s.kenyon{at}bham.ac.uk

Abstract

Objectives We sought evidence of effectiveness of lay support to improve maternal and child outcomes in disadvantaged families.

Design Prospective, pragmatic, individually randomised controlled trial.

Setting 3 Maternity Trusts in West Midlands, UK.

Participants Following routine midwife systematic assessment of social risk factors, 1324 nulliparous women were assigned, using telephone randomisation, to standard maternity care, or addition of referral to a Pregnancy Outreach Worker (POW) service. Those under 16 years and teenagers recruited to the Family Nurse Partnership trial were excluded.

Interventions POWs were trained to provide individual support and case management for the women including home visiting from randomisation to 6 weeks after birth. Standard maternity care (control) included provision for referring women with social risk factors to specialist midwifery services, available to both arms.

Main outcome measures Primary outcomes were antenatal visits attended and Edinburgh Postnatal Depression Scale (EPDS) 8–12 weeks postpartum. Prespecified, powered, subgroup comparison was among women with 2 or more social risks. Secondary outcomes included maternal and neonatal birth outcomes; maternal self-efficacy, and mother-to-infant bonding at 8–12 weeks; child development assessment at 6 weeks, breastfeeding at 6 weeks, and immunisation uptake at 4 months, all collected from routine child health systems.

Results Antenatal attendances were high in the standard care control and did not increase further with addition of the POW intervention (10.1 vs 10.1 (mean difference; MD) −0.00, 95% CI (95% CI −0.37 to 0.37)). In the powered subgroup of women with 2 or more social risk factors, mean EPDS (MD −0.79 (95% CI −1.56 to −0.02) was significantly better, although for all women recruited, no significant differences were seen (MD −0.59 (95% CI −1.24 to 0.06). Mother-to-infant bonding was significantly better in the intervention group for all women (MD −0.30 (95% CI −0.61 to −0.00) p=0.05), and there were no differences in other secondary outcomes.

Conclusions This trial demonstrates differences in depressive symptomatology with addition of the POW service in the powered subgroup of women with 2 or more social risk factors. Addition to existing evidence indicates benefit from lay interventions in preventing postnatal depression. This finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes.

Trial registration number ISRCTN35027323; Results.

  • PUBLIC HEALTH
  • OBSTETRICS
  • pregnancy
  • social/lay support

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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