Variation in pregnancy outcomes following statewide implementation of a prenatal home visitation program.
OBJECTIVE
To examine, following statewide dissemination, the influence of an evidence-based home visitation program for first-time mothers on reductions of subsequent pregnancies across time and different locations.


METHODS
Retrospective cohort study.


METHODS
Replication sites for the Nurse-Family Partnership (17 urban sites and 6 rural sites) across the Commonwealth of Pennsylvania between January 1, 2000, and December 31, 2007.


METHODS
A total of 3844 Nurse-Family Partnership clients matched by propensity score to 10 938 local-area controls.


METHODS
Program enrollment.


METHODS
Time to second pregnancy resulting in a live birth within 2 years of the first infant's birth.


RESULTS
There were no program effects on time to first pregnancy in the early years of the program (2000-2003), but clients whose first infants were born after 2003 had fewer second pregnancies compared with controls (hazard ratio = 0.87; 95% confidence interval, 0.80-0.96). This benefit occurred principally among mothers who were aged 18 years or younger (hazard ratio = 0.73, 95% confidence interval, 0.61-0.89) and was twice as strong among mothers aged 18 years or younger from rural locations (hazard ratio = 0.40; 95% confidence interval, 0.22-0.73) compared with those from urban locations (hazard ratio = 0.79; 95% confidence interval, 0.65-0.95).


CONCLUSIONS
Program effects on pregnancy planning emerged after an implementation period of 3 years in both urban and rural locations, but they were particularly strong in rural locations and among younger mothers.
Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA. rubin@email.chop.edu.
David M
DM
Rubin
Amanda L R
AL
O'Reilly
Xianqun
X
Luan
Dingwei
D
Dai
A Russell
AR
Localio
Cindy W
CW
Christian
D000293:Adolescent; D001721:Birth Intervals; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D007182:Income; D016015:Logistic Models; D008423:Maternal Age; D016389:Maternal-Child Nursing; D010414:Pennsylvania; D011247:Pregnancy; D011295:Prenatal Care; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019035:Rural Health Services; D019037:Urban Health Services