Objective Interventions to reduce health inequalities for young children and their mothers are important: involving peers is recommended, but evidence of value for this approach is limited. The authors aimed to examine the effect of an innovative tailored peer-mentoring programme, based on perceived needs, for first-time mothers in socio-economically deprived communities.

Design Randomised controlled trial; parallel qualitative study with purposive samples using semistructured interviews.

Setting Socio-economically disadvantaged areas, Belfast.

Participants Primigravidae, aged 16–30 years, without significant co-morbidity.

Intervention Peer-mentoring by a lay-worker fortnightly during pregnancy and monthly for the following year, tailored to participants' wishes (home visits/telephone contacts), additional to usual care.

Main outcome measures Infant psychomotor and mental development (Bayley Scales of Infant Development (BSID-II)) at 1 year, assessed by an observer blinded to group allocation. Mothers' health at 1 year postnatal (SF-36).

Results Of 534 women invited, 343(64%) participated; 85%, with their children, completed outcome assessments (140 of 172 intervention; 152 of 171 controls). Intervention and control groups did not differ in BSID-II psychomotor (mean difference 1.64, 95% CI −0.94 to 4.21) or mental (−0.81, −2.78 to 1.16) scores, nor SF-36 physical functioning (−5.4, −11.6 to 0.7) or mental health (−1.8, −6.1 to 2.6). Women valued advice given in context of personal experience of child-rearing. Mentors gained health-related knowledge, personal skills and new employment opportunities.

Conclusions Despite possible longer-term social advantage, this peer-mentoring programme showed no benefit for infant development or maternal health at 1 year. Further rigorous evaluation of important outcomes of complex interventions promoting health for children in socially disadvantaged communities is warranted.

Trial registration no ISRCTN 55055030