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 controlgroup 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.Address correspondence to David L. Olds, PhD, University of Colorado at Denver and Health Sciences Center, 1825 Marion St, Suite 200, Denver, CO 80218. olds.david@tchden.org. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 March 16. Published in final edited form as:Pediatrics. Home visiting by nurses for low-income, at-risk families has been promoted as a promising strategy for preventing child abuse and neglect, children's mental health problems, 1-3 and infant mortality. 4 Recent evidence suggests that the benefits hoped for from such programs do not hold for all types of home-visiting programs. 5 A program of home visiting by nurses known as the Nurse-Family Partnership (NFP) has produced consistent effects on several aspects of maternal and child heal...

Objective:To examine the effect of prenatal and infancy nurse home visitation on the life course development of 19-year-old youths whose mothers participated in the program.Design: Randomized trial.Setting: Semirural community in New York.Participants: Three hundred ten youths from the 400 families enrolled in the Elmira Nurse-Family Partnership program.Intervention: Families received a mean of 9 home visits (range, 0-16) during pregnancy and 23 (range, 0-59) from birth through the child's second birthday. Main Outcome Measures:Youth self-reports of educational achievement, reproductive behaviors, welfare use, and criminal involvement.Results: Relative to the comparison group, girls in the preg- For editorial comment see page 92Journal Club slides available at www.archpediatrics.com

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Objective-The goal was to describe the accuracy of the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory II (BDI-II), and Postpartum Depression Screening Scale (PDSS) in identifying major depressive disorder (MDD) or minor depressive disorder (MnDD) in low-income, urban mothers attending well childcare (WCC) visits during the postpartum year.Design/Methods-Mothers (N=198) attending WCC visits with their infants 0 to 14 months of age completed a psychiatric diagnostic interview (standard method) and 3 screening tools. The sensitivity and specificity of each screening tool were calculated in comparison with diagnoses of MDD or MDD/MnDD. Receiver operating characteristic curves were calculated and the areas under the curves for each tool were compared to assess accuracy for the entire sample (representing the postpartum year) and sub-samples (representing early, middle and late postpartum time frames). Optimal cut-points were calculated.Results-At some point between 2 weeks and 14 months postpartum, 56% of mothers met criteria for either MDD (37%) or MnDD (19%). When used as a continuous measures, all scales performed equally well (areas under the curves of ≥ 0.8). With traditional cut-points, the measures did not perform at the expected levels of sensitivity and specificity. Optimal cut-points for the BDI-II (≥14 for MDD, ≥11 for MDD/MnDD) and EPDS (≥9 for MDD, ≥7 for MDD/MnDD) were lower than currently recommended. For the PDSS, the optimal cut-point was consistent with current guidelines for MDD (≥80) but higher than recommended for MDD/MnDD (≥ 77). Conclusions-Large proportions of low-income, urban mothers attending WCC visits experience MDD or MnDD during the postpartum year. The EPDS, BDI-II and PDSS have high accuracy in identifying depression but cutoff points may need to be altered to more accurately identify depression in urban, low-income mothers.

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.

The incidence of all complications was higher than expected. Problems associated with long-term indwelling catheter use may contribute to excess healthcare utilization adversely affecting both users and their families.

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