Support during pregnancy for women at increased risk.

BACKGROUND: Studies consistently show a relationship between social disadvantage and low birthweight. OBJECTIVES: The objective of this review was to assess the effects of programs offering additional social support for pregnant women who are believed to be at risk for giving birth to preterm or low birthweight babies. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: April 1999. SELECTION CRITERIA: Randomised trials of additional support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. Additional support was defined as some form of emotional support (eg counselling, reassurance, sympathetic listening) and information/advice, either in home visits or during clinic appointments, and could include tangible assistance (eg transportation to clinic appointments, assistance with the care of other children at home). DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Fourteen trials, involving over 11,000 women, were included. The trials were generally of good to excellent quality, although three used a method likely to introduce bias. Programs offering additional social support for at risk pregnant women were not associated with improvements in any medical outcomes for the index pregnancy. Some improvements in immediate psychosocial outcomes were found in individual trials. REVIEWER'S CONCLUSIONS: Programs which offer additional support during pregnancy have not been shown to reduce the numbers of low birthweight or preterm babies or improve other important medical outcomes for mothers and babies.