Teenage pregnancies are linked to low socio-economic circumstances and have negative health impacts for both mothers and infants. The cost of supporting teenage mothers in the USA a decade ago was estimated to be around $21 billion a year. Julie Quinlivan from the University of Melbourne, Australia, and colleagues assessed whether a postnatal home-visiting service for teenage mothers younger than age 18 years could reduce the frequency of adverse neonatal outcomes and improve knowledge of contraception, breastfeeding, and infant vaccination schedules in this parent group.
139 teenage girls (average age 16 years) who attended a pregnancy clinic were randomly assigned to receive either five postnatal home visits by nurse-midwives or no intervention. An initial survey had assessed the girls' knowledge of contraception, infant vaccinations, and breastfeeding. The effect of home visits was assessed by a six-month follow-up survey given to all mothers in the trial.
There were fewer instances of adverse health outcomes of children whose mothers received home visits (two, compared with nine for the non-intervention group): there were two infant deaths among mothers not given home visits (both occurring at around two weeks after birth) compared with one infant death among mothers receiving home visits; six infants from the non-intervention group were placed in foster care compared with one child from mothers who received home visits. Home visits also substantially increased mothers' contraceptive use at six-month follow-up; however home visits did not increase mothers' knowledge with respect to breastfeeding or infant vaccination schedules.
Julie Quinlivan comments: "Teenage mothers are prepared to accept considerable changes in their lifestyles to facilitate a positive outcome for their child. Opportunities to intervene in the postnatal period exist and should be used. Home visiting programmes that target mothers younger than age 18 years might be able to reduce adverse neonatal outcomes. Improving knowledge and effective use of contraception could enable the teenage mother to plan her reproductive life. Further work needs to be done to investigate the long-term effects of home visiting programmes, and to devise strategies to increase the number of infants breastfed and the number who receive all their childhood vaccinations."
Contact: Dr Julie A Quinlivan, The University of Melbourne, University Department of Obstetrics and Gynaecology, Royal Women's Hospital, 132 Grattan St, Carlton, Victoria 3053, Australia;
T) 61-39-344-1230;
F) 61-39-347-1761;
E) julieq@unimelb.edu.au
Journal
The Lancet