OBJECTIVE To evaluate the effect of an intensive nurse home visiting program on postpartum contraceptive use and birth spacing among individuals with a first pregnancy who were eligible for Medicaid insurance in South Carolina. METHODS We conducted a nonblinded, randomized controlled trial of the Nurse-Family Partnership (NFP), an established intensive home visiting program that provides prenatal and postpartum home visits through 2 years after childbirth. The trial included patients who were eligible for Medicaid insurance with a first pregnancy at less than 28 weeks of gestation between April 1, 2016, and March 17, 2020, who were followed up through 2 years after childbirth. Participants were randomized 2:1 to NFP compared with standard of care treatment. The primary outcome was a birth interval of less than 21 months between the index pregnancy and a subsequent birth. The secondary outcomes were birth intervals of less than 15 and 24 months, receipt of a contraceptive implant or intrauterine device (IUD) immediately postpartum, any contraceptive use and receipt of a family planning visit (at both 6 weeks and 1 year postpartum), and IUD receipt at 1 year postpartum. We assessed outcomes using linked birth certificate records and Medicaid claims data. RESULTS A total of 4,932 trial participants (3,295 in the intervention group and 1,637 in the control group) were included in the study analysis. Within 21 months of the study index birth, 11.0% of individuals in the NFP group and 12.2% of the usual care group had a subsequent birth. The NFP did not have a statistically significant effect on birth intervals of less than 21 months (adjusted coefficient -1.1, 95% CI, -2.9 to 0.8). There were no statistically significant differences between the NFP and control groups for any of the study's eight secondary outcomes related to birth spacing and postpartum contraceptive use. CONCLUSION Home visits with a registered nurse did not affect postpartum contraceptive use or birth spacing. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03360539.

中文翻译：

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强化护士家访计划对产后避孕药具使用和生育间隔的影响：一项随机对照试验。


目的 评估强化护士家访计划对南卡罗来纳州有资格享受 Medicaid 保险的首次妊娠个体的产后避孕药具使用和生育间隔的影响。方法 我们进行了一项护士-家庭伙伴关系 （NFP） 的非盲、随机对照试验，这是一项已建立的强化家访计划，在产后 2 年内提供产前和产后家访。该试验纳入了在 2016 年 4 月 1 日至 2020 年 3 月 17 日期间首次怀孕且妊娠不到 28 周且符合医疗补助保险条件的患者，这些患者在分娩后接受了 2 年的随访。与标准护理治疗相比，参与者以 2：1 的比例随机分配到 NFP 组。主要结局是指数妊娠与后续分娩之间的出生间隔小于 21 个月。次要结局是小于 15 个月和 24 个月的出生间隔、产后立即接受避孕植入物或宫内节育器 （IUD）、任何避孕药具的使用和接受计划生育访视（产后 6 周和 1 年）以及产后 1 年接受宫内节育器。我们使用关联的出生证明记录和 Medicaid 索赔数据评估结局。结果 研究分析共纳入 4,932 名试验参与者 （干预组 3,295 名，对照组 1,637 名）。在研究指数出生后的 21 个月内，NFP 组中 11.0% 的个体和常规护理组中 12.2% 的个体随后出生。NFP 对小于 21 个月的出生间隔没有统计学意义影响 （校正系数 -1.1,95% CI，-2.9 至 0.8）。 该研究的 8 个次要结局中，与出生间隔和产后避孕药具使用相关的 NFP 组和对照组之间均无统计学意义差异。结论 注册护士的家访不影响产后避孕药具的使用或生育间隔。临床试验注册 ClinicalTrials.gov，NCT03360539。