A wide-ranging study of prenatal and postnatal nurse intervention for low-income mothers bearing their first children, published in the American Journal of Preventive Medicine, indicates promising results in reducing maternal mortality for external causes and child mortality for preventable causes.
This report extends a program of research conducted over decades, demonstrating benefits across three randomized trials of a program known today as Nurse-Family Partnership (NFP). In a large series of earlier reports, NFP has been found to improve pregnancy outcomes, child health and development, and family economic self-sufficiency. The most recent report examines program effects on maternal and child mortality.
In this study, researchers at the University of Colorado Anschutz Medical Campus analyzed four decades’ worth of data, collected between 1978 and 2015, examining the influence of prenatal, infant and toddler-stage home visits by nurses for mothers bearing first children and living in low-income neighborhoods in Memphis, Tennessee; Elmira, New York; and Denver, Colorado. More than 2,000 subjects in both urban and rural communities participated in a series of randomized clinical trials of NFP aimed at determining the impact of prenatal and infant/toddler nurse home visiting.
“It is rare for complex health and social interventions to be tested in randomized trials, the most scientifically credible way to determine their impact,” says corresponding author David Olds, PhD, professor of pediatrics at the University of Colorado School of Medicine. “These results underscore the importance of employing clinical trials to evaluate complex programs designed to address health and social problems.”
Nurses intervened beginning in pregnancy by forming respectful and empathic relationships with mothers. Nurses aimed to improve prenatal health; helped mothers respond effectively in caring for their babies; helped mothers plan the timing of subsequent pregnancies and make decisions about continuing their education and finding work; and encouraged family members to form a network of support for mothers.
As a result, replicated outcomes across at least two of the three trials showed significant reductions in prenatal tobacco use, reductions in hypertensive disorders of pregnancy, reductions in serious injuries to children, improvements in children’s language and cognitive development, reductions in closely-spaced subsequent pregnancies, reductions in families’ use of government benefits and greater supportive involvement on the part of partners and other family members.
In this most recent study, researchers found indications that mothers visited by NFP nurses in all three trials were less likely to have died of external causes, such as homicide or overdosing, over a two-decade period following the birth of their first child. In the Memphis trial, researchers also identified a trend for nurse-visited children to die less frequently for preventable causes over the first 25 years of life compared to those randomly assigned to the control group.
Results from these randomized trials, conducted in three different U.S settings and at different points in time, produced consistent improvements in the lives of low-income mothers and their children. These findings emphasize the need for these services in our society today, says Olds. “Improving the health of women and children in pregnancy and early years of life are crucial for setting them on a path toward healthy development over the life-course, including, it appears, avoiding premature death. We as a society have a responsibility to make sure that families in need are protected at the earliest stages of human development.”