Prenatal and Postnatal Home Visiting Programs for Parents, Newborns, and Babies: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

Six relevant publications (four randomized controlled trials and two non-randomized studies) were identified regarding the clinical effectiveness of prenatal and postnatal home visiting programs for mothers, newborns, and babies. One systematic review was identified regarding the cost-effectiveness of prenatal and postnatal home visiting programs for mothers, newborns, and babies up to two years of age. No relevant evidence-based guidelines were identified regarding the provision of home visiting programs for parents, newborns, or babies. 

Overall, there was evidence that care delivered in the prenatal and postnatal periods had both short- and long-term health outcomes. 

Regarding postnatal maternal health outcomes, one randomized controlled trial of limited quality demonstrated no statistically significant difference in incidence of completed postpartum visits by eight weeks postpartum or postpartum depression between postnatal home visit and standard office visit groups. There was evidence regarding postnatal child health outcomes from four randomized controlled trials and two quasi-experimental studies. Compared to those who received usual care, newborns and babies who received the Family Connects postnatal nurse home visiting program group were found to have statistically significantly reduced incidence of emergency medical care utilization or inpatient hospital overnight stay. Compared to standard care, infants who received a home-based early preventative care postnatal home visit program within their first year of life had a statistically significantly reduced likelihood of having a mathematics impairment and no statistically significant difference in serious adverse events, most developmental outcomes measured at age eight. Compared to no home visit, first-time mothers who received the Kentucky Health Access Nurturing Development Services prenatal and postnatal home visit program had a significantly reduced incidence of preterm birth, delivering low birth weight infants, and child maltreatment. Compared to no home visit, high-risk pregnancy women who received the public health nurse prenatal home visit program in Japan statistically significantly reduced the incidence of preterm birth. No statistically significant difference was found in the proportion of infants born small for gestational age between the group of high-risk pregnant women that received home visits from public health nurses and the group that did not receive home visits. No statistically significant difference was found between first-time teenage mothers who received the Family Nurse Partnership prenatal and postnatal home-visit program and those who received usual care in rates of emergency department attendances or hospital admissions. No statistically significant difference was found between pregnant women who received a postnatal newborn well-child home visits program and those who received standard office visits in the number of health checks, sick visits, or usage of urgent care. 

There was low-to-moderate quality evidence from seven studies in the systematic review of economic evaluations that home visiting programs were cost-effective in comparison to no home visits, depending on the willingness-to-pay threshold and the perspective of the payers.