Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial | Health Disparities | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.236.187.155. Please contact the publisher to request reinstatement.
1.
Murphy  SL, Xu  J, Kochabek  KD. National Vital Statistics Reports. Deaths: final data for 2010. National Vital Statistics Systems. 2013;61(4). http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf. Accessed May 23, 2014.
2.
Dowd  JB, Albright  J, Raghunathan  TE, Schoeni  RF, Leclere  F, Kaplan  GA.  Deeper and wider: income and mortality in the USA over three decades.  Int J Epidemiol. 2011;40(1):183-188.PubMedGoogle ScholarCrossref
3.
Ma  J, Xu  J, Anderson  RN, Jemal  A.  Widening educational disparities in premature death rates in twenty six states in the United States, 1993-2007.  PLoS One. 2012;7(7):e41560. doi:10.1371/journal.pone.0041560.PubMedGoogle ScholarCrossref
4.
Cullen  MR, Cummins  C, Fuchs  VR.  Geographic and racial variation in premature mortality in the U.S.: analyzing the disparities.  PLoS One. 2012;7(4):e32930. doi:10.1371/journal.pone.0032930.PubMedGoogle ScholarCrossref
5.
Jemal  A, Ward  E, Anderson  RN, Murray  T, Thun  MJ.  Widening of socioeconomic inequalities in U.S. death rates, 1993-2001.  PLoS One. 2008;3(5):e2181. doi:10.1371/journal.pone.0002181.PubMedGoogle ScholarCrossref
6.
Kindig  DA, Cheng  ER.  Even as mortality fell in most US counties, female mortality nonetheless rose in 42.8 percent of counties from 1992 to 2006.  Health Aff (Millwood). 2013;32(3):451-458.PubMedGoogle ScholarCrossref
7.
Wilper  AP, Woolhandler  S, Lasser  KE, McCormick  D, Bor  DH, Himmelstein  DU.  Health insurance and mortality in US adults.  Am J Public Health. 2009;99(12):2289-2295.PubMedGoogle ScholarCrossref
8.
Marmot  M, Friel  S, Bell  R, Houweling  TAJ, Taylor  S; Commission on Social Determinants of Health.  Closing the gap in a generation: health equity through action on the social determinants of health.  Lancet. 2008;372(9650):1661-1669.PubMedGoogle ScholarCrossref
9.
Shonkoff  JP, Garner  AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics.  The lifelong effects of early childhood adversity and toxic stress.  Pediatrics. 2012;129(1):e232-e246. doi:10.1542/peds.2011-2663.PubMedGoogle ScholarCrossref
10.
Powers  DA, Song  S.  Absolute change in cause-specific infant mortality for blacks and whites in the US: 1983-2002.  Popul Res Policy Rev. 2009;28:817-851.Google ScholarCrossref
11.
Singh  GK.  Youth Mortality in the United States, 1935-2007: Large and Persistent Disparities in Injury and Violent Deaths: A 75th Anniversary Publication. Rockville, MD: Health Resources and Services Administration, Maternal and Child Health Bureau, US Dept of Health and Human Services; 2010.
12.
Howell  E, Decker  S, Hogan  S, Yemane  A, Foster  J.  Declining child mortality and continuing racial disparities in the era of the Medicaid and SCHIP insurance coverage expansions.  Am J Public Health. 2010;100(12):2500-2506.PubMedGoogle ScholarCrossref
13.
Singh  GK, Kogan  MD.  Widening socioeconomic disparities in US childhood mortality, 1969–2000.  Am J Public Health. 2007;97(9):1658-1665.PubMedGoogle ScholarCrossref
14.
Matthews  TJ, MacDorman  MF.  Infant mortality statistics from the 2009 period linked birth/infant death data set.  NVSS. 2013;61(8):1-28.Google Scholar
15.
Moon  RY; Task Force on Sudden Infant Death Syndrome.  SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.  Pediatrics. 2011;128(5):e1341-e1367.doi:10.1542/peds.2011-2285. PubMedGoogle ScholarCrossref
16.
Schnitzer  PG, Covington  TM, Dykstra  HK.  Sudden unexpected infant deaths: sleep environment and circumstances.  Am J Public Health. 2012;102(6):1204-1212.PubMedGoogle ScholarCrossref
17.
Kendrick  D, Mulvaney  CA, Ye  L, Stevens  T, Mytton  JA, Stewart-Brown  S.  Parenting interventions for the prevention of unintentional injuries in childhood.  Cochrane Database Syst Rev. 2013;3:CD006020. doi:10.1002/14651858.CD006020.pub3.PubMedGoogle Scholar
18.
Olds  D, Pettitt  LM, Robinson  J,  et al.  Reducing risks for antisocial behavior with a program of prenatal and early childhood home visitation.  J Community Psychol. 1998;26:65-83.Google ScholarCrossref
19.
Kitzman  H, Olds  DL, Henderson  CR  Jr,  et al.  Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: a randomized controlled trial.  JAMA. 1997;278(8):644-652.PubMedGoogle ScholarCrossref
20.
Kitzman  H, Olds  DL, Sidora  K,  et al.  Enduring effects of nurse home visitation on maternal life course: a 3-year follow-up of a randomized trial.  JAMA. 2000;283(15):1983-1989.PubMedGoogle ScholarCrossref
21.
Olds  DL, Kitzman  H, Cole  R,  et al.  Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial.  Pediatrics. 2004;114(6):1550-1559.PubMedGoogle ScholarCrossref
22.
Olds  DL, Kitzman  H, Hanks  C,  et al.  Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial.  Pediatrics. 2007;120(4):e832-e845. doi:10.1542/peds.2006-2111.PubMedGoogle ScholarCrossref
23.
Kitzman  H, Olds  DL, Cole  R,  et al.  Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years.  Arch Pediatr Adolesc Med. 2010;164(5):412-418.PubMedGoogle Scholar
24.
Olds  DL, Kitzman  H, Cole  R,  et al.  Enduring effects of prenatal and infancy home visiting by nurses on maternal life-course and government spending: follow-up of a randomized trial among children at age 12 years.  Arch Pediatr Adolesc Med. 2010;164(5):419-424.PubMedGoogle Scholar
25.
Olds  DL.  Prenatal and infancy home visiting by nurses: from randomized trials to community replication.  Prev Sci. 2002;3(3):153-172.PubMedGoogle ScholarCrossref
26.
Olds  DL, Robinson  J, O’Brien  R,  et al.  Home visiting by paraprofessionals and by nurses: a randomized, controlled trial.  Pediatrics. 2002;110(3):486-496.PubMedGoogle ScholarCrossref
27.
Olds  DL, Robinson  J, Pettitt  L,  et al.  Effects of home visits by paraprofessionals and by nurses: age 4 follow-up results of a randomized trial.  Pediatrics. 2004;114(6):1560-1568.PubMedGoogle ScholarCrossref
28.
Olds  DL, Holmberg  JR, Donelan-McCall  N, Luckey  DW, Knudtson  MD, Robinson  J.  Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years.  JAMA Pediatr. 2014;168(2):114-121. PubMedGoogle ScholarCrossref
29.
Olds  DL, Henderson  CR  Jr, Tatelbaum  R, Chamberlin  R.  Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation.  Pediatrics. 1986;77(1):16-28.PubMedGoogle Scholar
30.
Olds  DL, Henderson  CR  Jr, Chamberlin  R, Tatelbaum  R.  Preventing child abuse and neglect: a randomized trial of nurse home visitation.  Pediatrics. 1986;78(1):65-78.PubMedGoogle Scholar
31.
Olds  DL, Henderson  CR  Jr, Tatelbaum  R, Chamberlin  R.  Improving the life-course development of socially disadvantagedparents: a randomized trial of nurse home visitation.  Am J Public Health. 1988;78(11):1436-1445.PubMedGoogle ScholarCrossref
32.
Olds  DL, Eckenrode  J, Henderson  CR  Jr,  et al.  Long-term effects of home visitation on maternal life course and child abuse and neglect: fifteen-year follow-up of a randomized trial.  JAMA. 1997;278(8):637-643.PubMedGoogle ScholarCrossref
33.
Olds  D, Henderson  CR  Jr, Cole  R,  et al.  Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial.  JAMA. 1998;280(14):1238-1244.PubMedGoogle ScholarCrossref
34.
Soares  JF,  Wu CF. Some restricted randomization rules in sequential designs.  Comm Stat Theory Methods. 1983;12(17):2017-2034.Google ScholarCrossref
35.
Olds  D, Kitzman  H, Cole  R, Robinson  J.  Theoretical and empirical foundations of a program of home visitation for pregnant women and parents of young children.  J Comm Psychol. 1997;25:9-25.Google ScholarCrossref
36.
Olds  DL. The prenatal/early infancy project. In: Price R, Cowen E, Lorion R, Ramos-McKay J, eds.  Fourteen Ounces of Prevention: A Casebook for Practitioners. Washington, DC: American Psychological Association; 1988:9-23.
37.
Cowper  DC, Kubal  JD, Maynard  C, Hynes  DM.  A primer and comparative review of major US mortality databases.  Ann Epidemiol. 2002;12(7):462-468.PubMedGoogle ScholarCrossref
38.
Centers for Disease Control and Prevention. Classification of Diseases and Injuries. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD-9/ucod.txt. Accessed March 4, 2014.
39.
Centers for Disease Control and Prevention; National Center for Health Statistics. International Classification of Diseases, Tenth Revision (ICD-10). http://www.cdc.gov/nchs/icd/icd10.htm. Accessed March 4, 2014.
40.
Kaplan  EL, Meier  P.  Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;53:457-481.Google ScholarCrossref
41.
Klein  JP.  Competing risks.  WIREs Comp Stat. 2010;2(3):333-339.Google ScholarCrossref
42.
Gray  RJ.  A class of K-sample tests for comparing the cumulative incidence of a competing risk.  Ann Stat. 1988;16(3):1141-1154.Google ScholarCrossref
43.
Clutton-Brock  TH.  The Evolution of Parental Care. Princeton, NJ: Princeton University Press; 1991.
44.
Mayes  LC, Swain  JE, Leckman  J.  Parental attachment systems: neural circuits, genes and experiential contributions to parental engagement.  Clin Neurosci Res. 2005;4(5):301-313.Google ScholarCrossref
45.
Leckman  JF, Feldman  R, Swain  JE, Eicher  V, Thompson  N, Mayes  LC.  Primary parental preoccupation: circuits, genes, and the crucial role of the environment.  J Neural Transm. 2004;111(7):753-771.PubMedGoogle ScholarCrossref
46.
Olds  DL, Sadler  L, Kitzman  H.  Programs for parents of infants and toddlers: recent evidence from randomized trials.  J Child Psychol Psychiatry. 2007;48(3-4):355-391.PubMedGoogle ScholarCrossref
47.
Zucchi  FC, Yao  Y, Ward  ID,  et al.  Maternal stress induces epigenetic signatures of psychiatric and neurological diseases in the offspring.  PLoS One. 2013;8(2):e56967. doi:10.1371/journal.pone.0056967.PubMedGoogle ScholarCrossref
48.
Leuner  B, Glasper  ER, Gould  E.  Parenting and plasticity.  Trends Neurosci. 2010;33(10):465-473.PubMedGoogle ScholarCrossref
49.
Kim  P, Leckman  JF, Mayes  LC, Feldman  R, Wang  X, Swain  JE.  The plasticity of human maternal brain: longitudinal changes in brain anatomy during the early postpartum period.  Behav Neurosci. 2010;124(5):695-700.PubMedGoogle ScholarCrossref
50.
Nierop  A, Wirtz  PH, Bratsikas  A, Zimmermann  R, Ehlert  U.  Stress-buffering effects of psychosocial resources on physiological and psychological stress response in pregnant women.  Biol Psychol. 2008;78(3):261-268.PubMedGoogle ScholarCrossref
Original Investigation
September 2014

Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial

Author Affiliations
  • 1Department of Pediatrics, School of Medicine, University of Colorado, Aurora
  • 2School of Nursing, University of Rochester, Rochester, New York
JAMA Pediatr. 2014;168(9):800-806. doi:10.1001/jamapediatrics.2014.472
Abstract

Importance  Mothers and children living in adverse contexts are at risk of premature death.

Objective  To determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a 2-decade period (1990-2011).

Design, Setting, and Participants  A randomized clinical trial was designed originally to assess the home visiting program’s effect on pregnancy outcomes and maternal and child health through child age 2 years. The study was conducted in a public system of obstetric and pediatric care in Memphis, Tennessee. Participants included primarily African American women and their first live-born children living in highly disadvantaged urban neighborhoods, who were assigned to 1 of 4 treatment groups: treatment 1 (transportation for prenatal care [n = 166]), treatment 2 (transportation plus developmental screening for infants and toddlers [n = 514]), treatment 3 (transportation plus prenatal/postpartum home visiting [n = 230]), and treatment 4 (transportation, screening, and prenatal, postpartum, and infant/toddler home visiting [n = 228]). Treatments 1 and 3 were included originally to increase statistical power for testing pregnancy outcomes. For determining mortality, background information was available for all 1138 mothers assigned to all 4 treatments and all but 2 live-born children in treatments 2 and 4 (n = 704). Inclusion of children in treatments 1 and 3 was not possible because background information was missing on too many children.

Interventions  Nurses sought to improve the outcomes of pregnancy, children’s health and development, and mothers’ health and life-course with home visits beginning during pregnancy and continuing through child age 2 years.

Main Outcomes and Measures  All-cause mortality in mothers and preventable-cause mortality in children (sudden infant death syndrome, unintentional injury, and homicide) derived from the National Death Index.

Results  The mean (SE) 21-year maternal all-cause mortality rate was 3.7% (0.74%) in the combined control group (treatments 1 and 2), 0.4% (0.43%) in treatment 3, and 2.2% (0.97%) in treatment 4. The survival contrast of treatments 1 and 2 combined with treatment 3 was significant (P = .007); the contrast of treatments 1 and 2 combined with treatment 4 was not significant (P = .19), and the contrast of treatments 1 and 2 combined with treatments 3 and 4 combined was significant (post hoc P = .008). At child age 20 years, the preventable-cause child mortality rate was 1.6% (0.57%) in treatment 2 and 0.0% (SE not calculable) in treatment 4; the survival contrast was significant (P = .04).

Conclusions and Relevance  Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings.

Trial Registration  clinicaltrials.gov Identifier: NCT00708695

×