Association of Prenatal Home Visiting Dosage on Preterm Birth in Oklahoma
Abstract
Preterm birth remains a substantial public health concern and leading cause of infant
morbidity and mortality. Many studies have focused on improving birth outcomes
through home visiting interventions, but few have measured dimensions of dosage and
the impact on preterm birth. This study investigated the association between dosage
effects of prenatal home visiting on preterm birth among a cohort of Children First
participants in Oklahoma. The life course framework guided the study in examining the
interactions of maternal risk factors and protective factors received through prenatal case
management that may help to reduce the risk of preterm birth. The research questions
incorporated dosage as the duration of enrollment, breadth of interventions, and amount
of contact time with the nurse in relation to the outcomes preterm birth within a diverse
racial-ethnic population. The retrospective cohort design utilized a convenience sample
of 5,659 participants drawn from the Children First database with 405 preterm deliveries.
Logistic regression models predicted that women enrolled in the program were 92.8%
less likely to deliver prematurely with every week increase in the duration of enrollment.
Participants were less likely to experience preterm birth with every 1-unit increase in
dosage of time percentage spent in health education and the number of referrals. Contact
time was not associated with preterm birth. Maternal race-ethnicity, age, number of
prenatal visits, and smoking during pregnancy were statistically associated with preterm
birth. These results may contribute to positive social change by preventing prematurity
and adverse pregnancy outcomes for at-risk women and children by increasing the dosage
of prenatal home visiting delivered by registered nurses.
