***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk , low-income black women attending a prenatal clinic in Clevel and . METHODS Based on previous research , risk was defined by clinic registration between the 17th and 28th weeks of gestation , low family functioning score , and experience of at least one stressful life event prior to registration . Optional factors included being a smoker , a low maternal weight-height ratio , being age 27 or older , and a previous premature birth . A 21-item family function screen previously vali date d in a similar population was the primary determinant of psychosocial risk . Low birth weight was defined as weight less than 2,500 g regardless of gestational age . RESULTS There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking , drug and nutrition education , support , and links with community services , compared to women who received no visits . The number of prenatal visits was significantly higher in the intervention group , but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight . Despite previous research , the family function screen was not an effective predictor of low birth weight in our study . A revised equation involving a history of previous premature birth , smoking , and a low maternal weight-height ratio did predict low birth weight . CONCLUSIONS These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic population s. The family function screen was not cross vali date d. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research We assessed the effectiveness of the home-visiting system in reducing the care provided in maternity units , especially hospitalization , and attempted to establish whether this system increases  women 's satisfaction with medical care . The trial involved 158 women and was conducted in four maternity units in Paris . A policy of one or two weekly visits by domiciliary midwives was compared with the usual policy of the hospitals . The study was restricted to women with moderate threatened preterm labor between 26 and 36 weeks of gestation . No decrease in the number of women hospitalized or the number of days spent in hospital was observed in the intervention group , but the number of prenatal visits to outpatient clinics was significantly smaller in the intervention than control group . Satisfaction with medical care during the episode of threatened preterm labor was much greater in the intervention group . Home visits by a midwife were considered by the women to be a better care system than numerous outpatient visits or hospitalization . Our results for medical care suggest that the introduction of the home-visiting system did not greatly alter medical practice in the maternity units , although this system had been design ed to avoid or reduce hospitalization We conducted a health technology assessment of the care of women with high-risk pregnancies in the South Wales valleys . Women in the control arm were intended to receive conventional care with st and ard midwifery visits . Women in the intervention arm received additional or longer visits and domiciliary fetal heart rate telemonitoring .  Eighty-one mothers were r and omized . There were significant differences in midwifery intervention re sources between domiciliary and control groups , with the former receiving a mean of 3.7 visits lasting 33.5 min , compared with 1.4 visits lasting 12.8 min for the latter . There were slightly more spontaneous labours and fewer Caesarean sections in the domiciliary group . Maternal satisfaction and anxiety were high in both groups . Domiciliary care increased the service costs by 21.02 per woman in terms of extra midwife travel and visiting time , and by a further £ 18.38 per woman in home monitoring equipment costs . This , however , was more than offset by health service savings from fewer clinic visits ( £ 35.60 ) and fewer clinic ultrasound scans ( £ 9.01 ) . Adding the reductions in lost productivity to women and their partners ( £ 34.51 ) suggests that domiciliary care was cheaper than conventional care , even if it did not greatly reduce inpatient days ( a reduction nonetheless saving £ 184.24 ) . While clinical processes were similar in both groups , there were useful practical advantages and savings for patients and the health service from the domiciliary intervention This article presents the methodology and baseline findings of a large multicenter trial involving four countries from Latin America ( Argentina , Brazil , Cuba , and Mexico ) . The study was a r and omized , controlled , single-masked trial to investigate the impact of social support during pregnancy on perinatal outcomes . Pregnant women with gestational ages between 15 and 22 weeks were screened in health facilities in the four countries . Those presenting with one or more risk factors for having a low-birthweight baby were invited to join the trial . A total of 2235 women -- between 500 and 600 in each country -- were r and omized into an intervention ( n = 1110 ) or a control ( n = 1125 ) group . Both groups were comparable in terms of nearly all baseline variables . The intervention group received a minimum of four visits at home by a trained health worker who provided direct emotional support , health education , and an attempt to enhance the woman 's social support network . Over 90 % of all women were evaluated at 36 weeks of pregnancy and soon after delivery , and 85 % at the 40th day postpartum . The outcomes under study included intrauterine growth retardation , gestational age , perinatal and maternal morbidity and mortality , labor interventions , psychological distress and characteristics of the social support network , among others . This trial showed that it was possible to select , screen , r and omize , visit , and evaluate a large number of women in four Latin American countries using a st and ardized methodology This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks ( smoking , environmental tobacco smoke exposure ( ETSE ) , depression , and intimate partner violence ( IPV ) ) in African-Americans is associated with improved pregnancy outcomes . A r and omized controlled trial targeting risks during pregnancy was conducted in the District of Columbia . African-American women were recruited if reporting at least one of the risks mentioned above . R and omization to intervention or usual care was site and risk specific . Sociodemographic , health risk and pregnancy outcome data were collected . Data on 819 women , and their singleton live born infants were analyzed using an intent-to-treat approach . Bivariate analyses preceded a reduced logistical model approach to eluci date the effect of the intervention on the reduction of prematurity and low birth weight . The incidence of low birthweight ( LBW ) was 12 % and very low birthweight ( VLBW ) was 1.6 % . Multivariate logistic regression results showed that depression was associated with LBW ( OR = 1.71 , 95 % CI = 1.12–2.62 ) . IPV was associated with preterm birth ( PTB ) and very preterm birth ( VPTB ) ( OR 1.64 , 95 % CI = 1.07–2.51 , OR = 2.94 , 95 % CI = 1.40–6.16 , respectively ) . The occurrence of VPTB was significantly reduced in the intervention compared to the usual care group ( OR = 0.42 , 95 % CI = 0.19 - 0.93 ) . Our study confirms the significant associations between multiple psycho-behavioral risks and poor pregnancy outcomes , including LBW and PTB . Our behavioral intervention with demonstrated efficacy in addressing multiple risk factors simultaneously reduced VPTB within an urban minority population A r and omized controlled trial including 2235 women at high risk of low birthweight was conducted in four Latin American institutions . The objective of this trial was to evaluate a  psychosocial support intervention during pregnancy aim ed at improving perinatal health and mothers ' psychosocial conditions . The core of the intervention was four to six home visits where emotional support , counseling and strengthening of the woman 's social network was provided . Outcomes were measured at 36 weeks of pregnancy , post-partum and 40 days after delivery . The intervention was not successful in either altering women 's perception of social support and satisfaction with the reproductive experience , as well as maternal and newborn 's health care . It is concluded that although high levels of psychosocial distress during pregnancy may play an independent role in determining adverse pregnancy outcomes , this adverse effect does not appear to be ameliorated by psychosocial interventions conducted only during pregnancy , particularly those of a magnitude that can be realistically implemented ( in content and frequency ) at public care services in most developing countries OBJECTIVE : To determine whether group prenatal care improves pregnancy outcomes , psychosocial function , and patient satisfaction and to examine potential cost differences . METHODS : A multisite r and omized controlled trial was conducted at two university-affiliated hospital prenatal clinics . Pregnant women aged 14–25 years ( n=1,047 ) were r and omly assigned to either st and ard or group care . Women with medical conditions requiring individualized care were excluded from r and omization . Group participants received care in a group setting with women having the same expected delivery month . Timing and content of visits followed obstetric guidelines from week 18 through delivery . Each 2-hour prenatal care session included physical assessment , education and skills building , and support through facilitated group discussion . Structured interviews were conducted at study entry , during the third trimester , and postpartum . RESULTS : Mean age of participants was 20.4 years ; 80 % were African American . Using intent-to-treat analyses , women assigned to group care were significantly less likely to have preterm births compared with those in st and ard care : 9.8 % compared with 13.8 % , with no differences in age , parity , education , or income between study conditions . This is equivalent to a risk reduction of 33 % ( odds ratio 0.67 , 95 % confidence interval 0.44–0.99 , P=.045 ) , or 40 per 1,000 births . Effects were strengthened for African-American women : 10.0 % compared with 15.8 % ( odds ratio 0.59 , 95 % confidence interval 0.38–0.92 , P=.02 ) . Women in group sessions were less likely to have suboptimal prenatal care ( P<.01 ) , had significantly better prenatal knowledge ( P<.001 ) , felt more ready for labor and delivery ( P<.001 ) , and had greater satisfaction with care ( P<.001 ) . Breastfeeding initiation was higher in group care : 66.5 % compared with 54.6 % , P<.001 . There were no differences in birth weight nor in costs associated with prenatal care or delivery . CONCLUSION : Group prenatal care result ed in equal or improved perinatal outcomes at no added cost . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00271960 LEVEL OF EVIDENCE : OBJECTIVE To examine prenatal , maternal , and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birth-weight infants in which half of the prenatal care was provided in women 's homes by nurse specialists with master 's degrees . STUDY DESIGN R and omized clinical trial . PATIENTS AND METHODS A sample of 173 women ( and 194 infants ) with high-risk pregnancies ( gestational or pregestational diabetes mellitus , chronic hypertension , preterm labor , or high risk of preterm labor ) were r and omly assigned to the intervention group ( 85 women and 94 infants ) or the control group ( 88 women and 100 infants ) . Control women received usual prenatal care . Intervention women received half of their prenatal care in their homes , with teaching , counseling , telephone outreach , daily telephone availability , and a postpartum home visit by nurse specialists with physician backup . RESULTS For the full sample , mean maternal age was 27 years ; 85.5 % of women were single mothers , 36.4 % had less than a high school education , 93.6 % were African American , and 93.6 % had public health insurance , with no differences between groups on these variables . The intervention group had lower fetal/infant mortality vs the control group ( 2 vs 9 ) , 11 fewer preterm infants , more twin pregnancies carried to term ( 77.7 % vs 33.3 % ) , fewer prenatal hospitalizations ( 41 vs 49 ) , fewer infant rehospitalizations ( 18 vs 24 ) , and a savings of more than 750 total hospital days and $ 2,496,145 [ corrected ] . CONCLUSION This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs OBJECTIVE : Examine frequency , timing , and reasons for maternal postpartum rehospitalizations and acute care visits 1 year postpartum after a high-risk pregnancy . STUDY DESIGN : Secondary analysis of data collected during a r and omized clinical trial of advanced practice nurses gives transitional care for women with high-risk pregnancies . The 171 women were primarily African American , never married , Medicaid eligible , diagnosed with pregestational diabetes ( 20 ) , gestational diabetes ( 23 ) , either diagnosed ( 48 ) or at risk ( 44 ) for preterm labor , and chronic hypertension ( 36 ) . RESULTS : Of the total rehospitalizations ( 17 % ) and acute care visits ( 32 % ) , over one third occurred in the first 8 weeks postpartum . Chronic hypertensives and gestational diabetics had the highest rate of 
    Output:
    
While programs which offer additional support during pregnancy are unlikely to prevent the pregnancy from result ing in a low birthweight or preterm baby , they may be helpful in reducing the likelihood of antenatal hospital admission and caesarean birth