Home visits during pregnancy and after birth for women with an alcohol or drug problem.

Background One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits. Objectives To determine the effects of home visits during pregnancy and/ or after birth for women with a drug or alcohol problem. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), CENTRAL (T h e C o c h r a n e L i b r a r y 2011, Issue 4 of 4), MEDLINE (1966 to 30 November 2011), EMBASE (1980 to 30 November 2011), CINAHL (1982 to 30 November 2011) and PsycINFO (1974 to 30 November 2011) supplemented by searches of citations from previous reviews and trials and contact with experts. Selection criteria Studies using random or quasi- random allocation of pregnant or postpartum women with a drug or alcohol problem to home visits. Trials enrolling high- risk women of whom more than 50% were reported to use drugs or alcohol were also eligible. Data collection and analysis Review authors performed assessments of trials independently. We performed statistical analyses using fixed- effect and random- effects models where appropriate. Main results Seven studies (reporting 803 mother- infant pairs) compared home visits mostly after birth with no home visits. Visitors included community health nurses, paediatric nurses, trained counsellors, paraprofessional advocates, midwives and layAfrican- Americanwomen. Several studies had significant methodological limitations. There was no significant difference in continued illicit drug use (three studies, 384 women; risk ratio (RR) 1.05, 95% confidence interval (CI) 0.89 to 1.24), continued alcohol use (three studies, 379 women; RR 1.18, 95% CI 0.96 to 1.46), failure to enrol in a drug treatment program (two studies, 211 women; RR 0.45, 95% CI 0.10 to 1.94), not breastfeeding at six months (two studies, 260 infants; RR 0.95, 95% CI 0.83 to 1.10), incomplete six- month infant vaccination schedule (two studies, 260 infants; RR 1.09, 95% CI 0.91 to 1.32), the BayleyMental Development Index (three studies, 199 infants; mean difference 2.89, 95% CI - 1.17 to 6.95) or Psychomotor Index (MD 3.14, 95% CI - 0.03 to 6.32), child behavioural problems (RR 0.46, 95% CI 0.21 to 1.01), infants not in care of biological mother (two studies, 254 infants; RR 0.83, 95% CI 0.50 to 1.39), non- accidental injury and non- voluntary foster care (two studies, 254 infants; RR 0.16, 95% CI 0.02 to 1.23) or infant death (three studies, 288 infants; RR 0.70, 95% CI 0.12 to 4.16). Individual studies reported a significant reduction in involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74) and failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82). Author's conclusions There is insufficient evidence to recommend the routine use of home visits for pregnant or postpartum women with a drug or alcohol problem. Further large, high- quality trials are needed.