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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.”
Olds DL et al. Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr 2014 Jul 7; [e-pub ahead of print]. (http://dx.doi.org/10.1001/jamapediatrics.2014.472)
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.