Enduring effects of nurse home visitation on maternal life course - A 3-year follow-up of a randomized trial

Context A home visitation program using nurses to improve maternal and chil d outcomes had favorable results in a randomized trial with a primarily whi te, semirural population, Many of the short-term findings have been replica ted with urban blacks, but whether the program will continue to demonstrate effectiveness after its conclusion is uncertain. Objective To determine the effectiveness of a prenatal and infancy home vis itation program on the maternal life course of women in an urban environmen t 3 years after the program ended. Design and Setting Th ree-year follow-up of a randomized controlled trial o f women seen consecutively between June 1990 and August 1991 at an obstetri cal clinic in Memphis, Tenn, who were enrolled in a visitation program for 2 years after the birth of their first child. Participants A cohort of 743 women who were primarily black, were pregnant for less than 29 weeks, had no previous live births, and had at least 2 soc iodemographic risk factors (unmarried, <12 years of education, or unemploye d). Intervention An average of 7 (range, 0-18) home visits during pregnancy and 26 (range, 0-71) from birth to the child's second birthday. Main Outcome Measures Rate of subsequent pregnancy, mean interval between f irst and second birth, and mean number of months of welfare use. Results Compared with the control group, women who received home visits by nurses had fewer subsequent pregnancies (1.15 vs 1.34; P=.03), fewer closel y spaced subsequent pregnancies (0.22 vs 0.32; P=.03), longer intervals bet ween the birth of the first and second child (30.25 vs 26.60 months; P=.004 ), and fewer months of using Aid to Families with Dependent Children (32.55 vs 36.19; P=.01) and food stamps (41.57 vs 45.04; P=.005). Compared with t he effect of the program while the program was in operation, the effect aft er it ended was essentially equal for Aid to Families with Dependent Childr en, greater for food stamps, greater for rates of closely spaced subsequent pregnancies, and smaller for rates of subsequent pregnancy overall. Conclusions We found enduring effects of a home visitation program on the l ives of black women living in an urban setting. While these results were sm aller in magnitude than those achieved in a previous trial with white women living in a semirural setting, the direction of the effects was consistent across the 2 studies.