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Home Nurse Visits Linked to Improved Survival in New Mothers and Children

Summary and Comment |
August 5, 2014

Home Nurse Visits Linked to Improved Survival in New Mothers and Children

  1. Martin T. Stein, MD and
  2. Kelly Young, Physician's First Watch

Having nurses visit the homes of women from pregnancy through early childhood is associated with improved longer-term maternal and childhood survival.

  1. Martin T. Stein, MD and
  2. Kelly Young, Physician's First Watch

More than 1100 pregnant women, primarily African-American, who were less than 29 weeks' gestation and had not given birth before, were randomized to one of four groups:

  • Treatment 1: free transportation to prenatal appointments.

  • Treatment 2: treatment 1, plus developmental screening and referrals for their children up to age 2 years.

  • Treatment 3: treatment 1, plus roughly seven prenatal nurse home visits and two postpartum visits.

  • Treatment 4: treatment 3, plus home visits for their child up to age 2 years (mean number of visits, 33), plus developmental screening and referrals.

At a mean follow-up of 21 years, treatment group 3, which included nurse home visits, had significantly lower all-cause maternal mortality rates than the control group, consisting of combined treatments 1 and 2 (0.4% vs. 3.7%). Preventable child mortality up to age 20 was significantly lower with treatment group 4 than with the control group (0% vs. 1.6%). The authors conclude: “These findings suggest that this intervention may have longer-term effects on health and mortality as the mothers and their children grow older.”

Comment — Pediatrics and Adolescent Medicine

David Olds pioneered studies of nurse home visiting programs in disadvantaged families that have shown significant maternal and child benefits. Now, after 2 decades of follow-up, seven prenatal and two postpartum nurse home visits significantly lowered maternal mortality rates. The addition of nurse home visits until age 2 years significantly reduced preventable child mortality (sudden infant death syndrome, unintentional injuries, and homicide) up to age 20 years. The authors provide a reasoned explanation for these findings: “Nurses' support of mothers' efforts to protect themselves and their offspring is likely to buffer the damaging effects of toxic stress … [and help mothers anticipate] risk and regulated behaviors (e.g., wearing seat belts and avoiding criminally involved individuals).” This study shows long-term maternal and child benefits from a home visiting program for disadvantaged families, and I suspect middle class families would also benefit from similar programs in many European countries.

  • Disclosures for Martin T. Stein, MD at time of publication Consultant / Advisory board BioBehavioral Diagnostics; University of British Columbia Speaker’s bureau Memorial Health Care System, Hollywood, FL; Kaiser Permanante, So. California; America Academy of Pediatrics Editorial boards Journal of Developmental and Behavioral Pediatrics

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