A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents

Author(s):Show less -

Fatori, Daniel ^[1] ; Zuccolo, Pedro Fonseca ^[1] ; Shephard, Elizabeth ^[1] ; Brentani, Helena ^[1] ; Matijasevich, Alicia ^[2] ; Archanjo Ferraro, Alexandre ^[3] ; Aparecida Fracolli, Lislaine ^[4] ; Chiesa, Anna Maria ^[4] ; Leckman, James ^[5] ; Constantino Miguel, Euripedes ^[1] ; Polanczyk, Guilherme V. ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med FMUSP, Dept Psiquiatria, R Dr Ovidio Pires de Campos 785, BR-05403903 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Fac Med FMUSP, Dept Med Prevent, Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Fac Med FMUSP, Dept Pediat, Sao Paulo, SP - Brazil

^[4] Univ Sao Paulo, Dept Enfermagem Saude Coletiva Escola Enfermagem, Sao Paulo, SP - Brazil

^[5] Yale Univ, Sch Med, Yale Child Study Ctr, New Haven, CT - USA

• Document type: Journal article
• Source: SCIENTIFIC REPORTS; v. 11, n. 1 JUL 13 2021.
• Web of Science Citations: 0

Abstract

To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Lacos, a nurse HVP for adolescent mothers living in a poor urban area of SAo Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Lacos (intervention group, n=40) or healthcare as usual (control group, n=40). Primeiros Lacos is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child's age of 24 months. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child's age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen's d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient=0.89, 95% CI {[}0.18, 1.61], p=0.014), maternal emotional/verbal responsivity (coefficient=0.97, 95% CI {[}0.37, 1.58], p=0.002), and opportunities for variety in daily stimulation (coefficient=0.37, 95% CI {[}0.09, 0.66], p=0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Lacos is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Lacos potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818). (AU)

• FAPESP's process: 16/13451-9 - Developing ecological and frequent measures of cognitive and psychosocial stimulation in childhood in the context of a home visitation program for pregnant youth
• Grantee: Daniel Graça Fatori de Sá
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 16/22455-8 - Early childhood interventions and trajectories of cognitive, social and emotional development
• Grantee: Guilherme Vanoni Polanczyk
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/22396-7 - A multimodal neuroimaging investigation of changes in neural circuitry during early interventions for neurodevelopmental disorders
• Grantee: Elizabeth Shephard
• Support Opportunities: Scholarships in Brazil - Post-Doctoral