Home Visits by Nurse May Help Reduce Mortality in Moms, Children

Bottom Line: Women who had prenatal and infant/toddler nurse visits at home were less likely to die than women who did not and children whose mothers were visited by nurses were less likely to have died by age 20 from preventable causes.

Author: David L. Olds, Ph.D., of the University of Colorado, Aurora, and colleagues.

Background: Since 1990, the authors have been conducting a randomized clinical trial of a program of prenatal and infant/toddler home visits by nurses for very low-income, largely black mothers, having their first child.

How the Study Was Conducted: The study assigned 1,138 mothers 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/postnatal home visits, n=230), and treatment 4 (transportation, screening, and prenatal, postpartum, and infant/toddler home visits through age 2 years, n=228). The authors analyzed all cause-mortality in mothers and preventable-cause mortality, including sudden infant death syndrome, unintentional injury and homicide, in children. The study period stretched from 1990 to 2011. The goal of the nurses is to improve maternal and child health by helping to support women’s motivations to protect their children and themselves.

Results: The average 21-year maternal all-cause mortality rate was 3.7 percent in the combined control group (treatments 1 and 2), 0.4 percent in treatment 3, and 2.2 percent in treatment 4. When the children were 20 years of age, the preventable-cause child mortality rate was 1.6 percent in treatment 2 and 0 percent in treatment 4.

Conclusion: “These findings should be replicated in well-powered trials with populations at very high levels of familial and neighborhood risk.”

(JAMA Pediatr. Published online July 7, 2014. doi:10.1001/jamapediatrics.2014.472.