Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of a Randomized Trial

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Abstract
OBJECTIVE. Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers9 fertility and children9s 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 weeks9 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; mothers9 stability of relationships with partners and relationships with the biological father of the child; mothers9 use of welfare, food stamps, and Medicaid; mothers9 use of substances; mothers9 arrests and incarcerations; and children9s academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women9s employment, experience of domestic violence, and children9s 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 women9s rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children9s academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.