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Support during pregnancy for women at increased risk of low birthweight babies

  • Review
  • Intervention




Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programs offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programs may include advice and counseling (about nutrition, rest, stress management, alcohol and recreational drug use), tangible assistance (e.g., transportation to clinic appointments, help with household responsibilities), and emotional support. The programs may be delivered by multidisciplinary teams of health professionals, by specially trained lay workers, or by a combination of lay and professional workers.


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

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009).

Selection criteria

Randomized 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 (e.g., counseling, reassurance, sympathetic listening) and information or advice or both, either in home visits or during clinic appointments, and could include tangible assistance (e.g., transportation to clinic appointments, assistance with the care of other children at home).

Data collection and analysis

We independently assessed trial quality and extracted data. Double data entry was performed. We contacted study authors to request additional information.

Main results

Eighteen trials, involving 12,658 women, were included. The trials were generally of good to excellent quality, although three used an allocation method likely to introduce bias. Programs offering additional social support for at-risk pregnant women were not associated with improvements in any perinatal outcomes, but there was a reduction in the likelihood of caesarean birth and an increased likelihood of elective termination of pregnancy. Some improvements in immediate maternal psychosocial outcomes were found in individual trials.

Authors' conclusions

Pregnant women need the support of caring family members, friends, and health professionals. While programs which offer additional support during pregnancy are unlikely to prevent the pregnancy from resulting in a low birthweight or preterm baby, they may be helpful in reducing the likelihood of caesarean birth.

Plain language summary

Support during pregnancy for women at increased risk of low birthweight babies

Programs offering additional support during pregnancy were not effective in reducing number of babies born too early and babies with low birthweights.

Babies born to mothers in socially disadvantaged situations are more likely to be small and so have health problems. Programs providing emotional support, practical assistance, and advice have been offered in addition to usual care. The Review of 18 randomized controlled trials, involving 12,658 women, found that women who received additional support during pregnancy were less likely to have a caesarean birth and some were more likely to choose to terminate the pregnancy. However, the additional support did not reduce the likelihood of giving birth too early or that the baby was smaller than expected. There may be benefits in terms of lower anxiety and feeling better about their care.