Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial

• Published in: Pediatrics (Evanston) 2019-12, Vol.144 (6), p.e20183876
• Main Authors: Kitzman, Harriet, Olds, David L, Knudtson, Michael D, Cole, Robert, Anson, Elizabeth, Smith, Joyce A, Fishbein, Diana, DiClemente, Ralph, Wingood, Gina, Caliendo, Angela M, Hopfer, Christian, Miller, Ted, Conti, Gabriella
• Format: Article
• Language: English
• Subjects: Adolescent; Clinical trials; Cognition - physiology; Cognitive ability; Drug abuse; Female; Females; Follow-Up Studies; Health Risk Behaviors - physiology; Health risks; Health visiting; HIV; Home Care Services - trends; House Calls - trends; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Intelligence; Language; Male; Nurses, Community Health - trends; Offspring; Pediatrics; Poverty - trends; Pregnancy; Prenatal Care - methods; Prenatal Care - trends; Substance use; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2018-3876

Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening ( = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; = .08). There were no intervention effects on other behaviors. The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.