Effect of personalized home-based support for pregnant women on pregnancy outcomes: a cluster randomized trial

BACKGROUND: Anemia during pregnancy has been linked to higher maternal and perinatal morbidity and mortality. The purpose of this study is to examine the impact of individualized home-based care for pregnant women on pregnancy outcomes. METHODS: This was a cluster-randomized experiment done in Burkina Faso’s Sindou health area between 2015 and 2016. The intervention included a monthly home-based visit focused on nutritional counseling and pregnancy monitoring for pregnant women, and a training on nutrition for pregnant women, prevention of anemia in pregnancy, and management of anemia in pregnancy for health facility teams. In the control group, prenatal care was administered in accordance with national program guidelines. The primary outcome was the reported prevalence of anemia in pregnancy. The secondary outcomes of stillbirth, preterm birth, low birth weight, and abortion were evaluated using a difference in differences analysis and mixed models across the two groups. The sample consisted of 617 pregnant women, with 440 women assigned to the intervention group and 177 assigned to the control group. No maternal fatalities occurred in either group. The intervention decreased stillbirths by -1.6% (95% confidence interval: -3.1% to - 0.1%). It had no impact on the rates of low birth weight, premature birth, and abortion. CONCLUSION: In rural Burkina Faso, personalized support of pregnant women at home, in conjunction with appropriate prenatal care, reduced stillbirths, but not the rates of low birth weight, preterm birth, or abortion.