Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial.
BACKGROUND
Interest in home-visitation services as a way of improving maternal and child outcomes has grown out of the favorable results of a trial in semirural New York. The findings have not been replicated in other populations.


OBJECTIVE
To test the effect of prenatal and infancy home visits by nurses on pregnancy-induced hypertension, preterm delivery, and low birth weight; on children's injuries, immunizations, mental development, and behavioral problems; and on maternal life course.


METHODS
Randomized controlled trial.


METHODS
Public system of obstetric care in Memphis, Tenn.


METHODS
A total of 1139 primarily African-American women at less than 29 weeks' gestation, with no previous live births, and with at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed).


METHODS
Nurses made an average of 7 (range, 0-18) home visits during pregnancy and 26 (range, 0-71) visits from birth to the children's second birthdays.


METHODS
Pregnancy-induced hypertension, preterm delivery, low birth weight, children's injuries, ingestions, and immunizations abstracted from medical records; mothers' reports of children's behavioral problems; tests of children's mental development; mothers' reports of subsequent pregnancy, educational achievement, and labor-force participation; and use of welfare derived from state records.


RESULTS
In contrast to counterparts assigned to the comparison condition, fewer women visited by nurses during pregnancy had pregnancy-induced hypertension (13% vs 20%; P=.009). During the first 2 years after delivery, women visited by nurses during pregnancy and the first 2 years of the child's life had fewer health care encounters for children in which injuries or ingestions were detected (0.43 vs 0.55; P=.05); days that children were hospitalized with injuries or ingestions (0.03 vs 0.16; P<.001); and second pregnancies (36% vs 47%; P=.006). There were no program effects on preterm delivery or low birth weight; children's immunization rates, mental development, or behavioral problems; or mothers' education and employment.


CONCLUSIONS
This program of home visitation by nurses can reduce pregnancy-induced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.
Kitzman
H
H
School of Nursing, University of Rochester, NY, USA.
Olds
D L
DL
Henderson
C R
CR
Hanks
C
C
Cole
R
R
Tatelbaum
R
R
McConnochie
K M
KM
Sidora
K
K
Luckey
D W
DW
Shaver
D
D
Engelhardt
K
K
James
D
D
Barnard
K
K
D002657:Child Development; D003152:Community Health Nursing; D005260:Female; D006792:House Calls; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn; D008425:Maternal Behavior; D008427:Maternal Health Services; D015233:Models, Statistical; D011203:Poverty; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D015406:Single Parent; D013714:Tennessee / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000517:prevention & control