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Effect of Prenatal and Infancy Home Visitation by Nurses on Pregnancy Outcomes, Childhood Injuries, and Repeated Childbearing A Randomized Controlled Trial

Harriet Kitzman, RN, PhD; David L. Olds, PhD; Charles R. Henderson Jr; Carole Hanks, RN, DrPH; Robert Cole, PhD; Robert Tatelbaum, MD; Kenneth M. McConnochie, MD, MPH; Kimberly Sidora, MPH; Dennis W. Luckey, PhD; David Shaver, MD; Kay Engelhardt, RN, PhD; David James, MD; Kathryn Barnard, RN, PhD
JAMA. 1997;278(8):644-652. doi:10.1001/jama.1997.03550080054039.
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Context.  —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.

Design.  —Randomized controlled trial.

Setting.  —Public system of obstetric care in Memphis, Tenn.

Participants.  —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).

Intervention.  —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.

Main Outcome Measures.  —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.

Main 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.

Conclusion.  —This program of home visitation by nurses can reduce pregnancyinduced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.


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