Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial

Abstract

Objective: Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2.

Methods: We conducted a randomized, controlled trial in a public system of obstetric and pediatric care. A total of 743 primarily black women <29 weeks' gestation, with previous live births and at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality.

Results: Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with control-group counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes.

Conclusions: By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.

FIGURE 1

Program impact on number of subsequent children who were born to mothers after birth of first child by maternal psychological resources.

FIGURE 2

Program impact on duration of partner relations at 6 and 9 years after birth of first child.

FIGURE 3

Program impact on use of AFDC/TANF (mean number of months per year) after birth of first child.

FIGURE 4

Program impact on use of food stamps (mean number of months per year) after birth of first child.

FIGURE 5

Program impact on maternal mastery over time.

FIGURE 6

Program impact on children’s GPAs in reading and math by grade level and maternal psychological resources.