Nurse home visits to low income, first time mothers reduced pregnancy induced hypertension and childhood injuries
Question Do prenatal and postnatal home visits by nurses improve maternal and child outcomes?
Design
Randomised controlled trial with ≤2 years follow up.
Setting
Public obstetrics clinic in Memphis, Tennessee, USA.
Participants
1139 women (mean age 18 y, 92% African-American) who were <29 weeks gestation, had no previous live births, no chronic illnesses, and ≥2 sociodemographic risk factors (unmarried, <12 y education, and unemployed). Most were unmarried (98%), ≤18 years (64%), and had incomes at or below poverty guidelines (85%).
Intervention
Stratified by maternal race, age, gestational age, employment status, and geographic region, women were allocated to 1 of 4 treatment groups: (1) transportation to prenatal care (n=166); (2) treatment 1 plus developmental screening at 6, 12, and 24 months (n=515); (3) treatment 2 plus prenatal nurse home visits (mean 7 visits) (n=230); or (4) treatment 3 plus 2 years of postpartum home visits (mean 26 visits) (n=228). Groups 2 and 4 were followed up for 2 years (90% follow up based on completed office assessments); groups 1 and 3 were followed up until delivery (95% follow up based on newborn infants' records abstracted).
Main outcome measures
Pregnancy induced hypertension; preterm delivery; low birth weight; subsequent pregnancies; mothers' child rearing beliefs, education, and employment; quality of the home environment; children's …
