Recruitment for a community-based study of early pregnancy: the Right From The Start study

Despite the high incidence of spontaneous abortion, little is known about its causes, in part because of the challenge of assembling a large cohort of women in early pregnancy for prospective study. We describe the effectiveness of recruitment strategies used in Right From The Start (RFTS), a prospective, community-based study of spontaneous abortion. Between December 2000 and September 2002, 803 pregnant women enrolled in RFTS, 103 of whom were recruited while trying to conceive. The mean gestational age at enrollment was 52 days, with 25% of the cohort enrolling before 6 completed weeks' gestation. Participants recruited directly from the community typically enrolled earlier in their pregnancies (mean of 44 days) and accounted for 24% of the total cohort and 83% of all participants who were recruited while trying to conceive. Posting brochures in drug stores and targeted mailings to new homeowners were the most effective community recruitment strategies. Recruitment at private and public prenatal care sites accounted for 57% and 19% of the participants respectively. Recruitment from public clinics required direct contact by RFTS staff and yielded women who enrolled at later gestational ages (mean of 58 days), but was valuable for inclusion of minorities and lower income women with less favourable health behaviours. Although intensive, diverse efforts were required, when recruitment efforts were maximised, we successfully recruited over 10% of the estimated number of pregnant women in the community.