Influence of Prenatal and Early Childhood Home-Visiting by Nurses on Development of Chronic Disease

January 15, 2026 updated by: University of Colorado, Denver

Influence of Prenatal and Early Childhood Home-Visiting by Nurses on Development of Chronic Disease: 29-year Follow-Up of a Randomized Clinical Trial

This study is a longitudinal cohort study that follows participants in a randomized clinical trial of a program of prenatal and early child home visiting on maternal and offspring risks for chronic disease.

Study Overview

Detailed Description

Addressing the unacceptably high rates of chronic disease and premature mortality among low-income African Americans (AA) is a public health imperative. The proposed study addresses this challenge by building upon decades of follow-up of low-income, primarily AA participants in a randomized clinical trial of the Nurse-Family Partnership (NFP), a program of prenatal and infant/toddler nurse home visiting for low-income mothers with no previous live births. It examines NFP effects on risks for cardiovascular disease (CVD), type 2 diabetes (T2D), and chronic kidney disease (CKD), as well as premature mortality among both mothers and their first-born offspring at offspring age 30. It is the first adequately powered study of a very early intervention to examine risks for chronic disease and mortality, assessing both mothers and their first-born offspring.

Please note that for this section of the longitudinal study, just the outcome measures for 30 years after delivery are being measured. The study team also measured these outcome measures at baselines, 12 years, and 18 years after delivery in other studies, but for this specific study, the time frame for the listed outcome measures is 30 years after delivery.

Study Type

Interventional

Enrollment (Actual)

1055

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Colorado
      • Aurora, Colorado, United States, 80045
        • University of Colorado Anschutz Medical Campus

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Mothers who participated in a randomized clinical trial of nurse home visiting and their first-born offspring.
  • Women < 29 weeks pregnant --> No previous live births
  • No specific chronic illnesses thought to contribute to fetal growth retardation or preterm delivery
  • At least two of the following sociodemographic risk conditions: unmarried, less than 12 years of education, and unemployed

Exclusion Criteria:

  • Participants who refused assessments at earlier phases of data gathering.
  • Women > 29 weeks pregnant
  • Previous live births
  • Possessing chronic illnesses like hypertensive disorders requiring medical treatment, severe cardiac disease, large uterine fibroids.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Arm 1. Transportation and Screening
Free transportation for scheduled prenatal care, developmental screening and referral services for the child at the 6th, 12th, and 24th months of the child's life.
Arm 1. Transportation and Screening The 514 families in this condition received: 1) free transportation for scheduled prenatal care; and 2) developmental screening and referral services for the child at the 6th, 12th, and 24th months of the child's life.
Experimental: Arm 2. Transportation, Screening, and Nurse-Visitation during Pregnancy and Infancy
Free transportation for scheduled prenatal care; intensive nurse home-visitation services during pregnancy and through the child's second birthday; and developmental screening and referral services for the child at the 6th, 12th, and 24th months of the child's life.

Arm 2. Transportation, Screening, and Nurse-Visitiation During Pregnancy and Infancy

The 228 families in this condition received: 1) free transportation for scheduled prenatal care; 2) intensive nurse home-visitation services during pregnancy and through the child's second birthday; and 3) developmental screening and referral services for the child at the 6th, 12th, and 24th months of the child's life.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Height (standing)
Time Frame: Approximately 30 years after delivery
Description: height measured in cm while participant is standing in bare feet using a stationary stadiometer with headpiece
Approximately 30 years after delivery
Weight
Time Frame: Approximately 30 years after delivery
weight measured in pounds
Approximately 30 years after delivery
Waist circumference
Time Frame: once, approximately 30 years after delivery.
waist circumference measured in cm, after exhaling, just above iliac crest, using a non-stretchable cloth measuring tape.
once, approximately 30 years after delivery.
Hip circumference
Time Frame: once, approximately 30 years after delivery
hip circumference measured in cm, at point of greatest protrusion of gluteal muscles, using a non-stretchable cloth.
once, approximately 30 years after delivery
Percent total body fat
Time Frame: once, approximately 30 years after delivery
Measured using the Tanita-780U Multifrequency Segmental Body Composition Analyzer
once, approximately 30 years after delivery
% body fat in arms, legs
Time Frame: once, approximately 30 years after delivery
Measured using the Tanita-780U Multifrequency Segmental Body Composition Analyzer
once, approximately 30 years after delivery
Visceral (trunk) fat
Time Frame: once, approximately 30 years after delivery
Measured using the Tanita-780U Multifrequency Segmental Body Composition Analyzer
once, approximately 30 years after delivery
Total Cholesterol (TC), High density lipoprotein (HDL), Low density lipoprotein (LDL)
Time Frame: once, approximately 30 years after delivery
TC, HDL, and LDL are measured by a clinical laboratory from serum samples by Medpace Laboratories.
once, approximately 30 years after delivery
Triglycerides
Time Frame: once, approximately 30 years after delivery
Measured by a clinical laboratory from serum samples by Medpace Laboratories
once, approximately 30 years after delivery
Glycosylated hemoglobin
Time Frame: once, approximately 30 years after delivery
Measured by a clinical laboratory from whole blood samples by Medpace Laboratories
once, approximately 30 years after delivery
Insulin-like growth factor 1 (IGF-1)
Time Frame: once, approximately 30 years after delivery
IGF-1 is a hormonal mediator and is analyzed in serum by Medpace Laboratories.
once, approximately 30 years after delivery
Follicle-Stimulating Hormone (FSH)
Time Frame: once, approximately 30 years after delivery
FSH is an indicator of menopausal status and is measured in serum by the Medpace Laboratories.
once, approximately 30 years after delivery
Urine-Albumin
Time Frame: once, approximately 30 years after delivery
URINE albumin is measured by Medpace Laboratories
once, approximately 30 years after delivery
Urine Creatinine
Time Frame: once, approximately 30 years after delivery
Urine creatinine is measured in urine by Medpace Laboratories.
once, approximately 30 years after delivery
Estimated Glomerular Filtration Rate (eGFR)
Time Frame: once, approximately 30 years after delivery
eGFR (estimated glomerular filtration rate) is calculated based on serum creatinine value, age, and gender; measured by Medpace Laboratories.
once, approximately 30 years after delivery
High sensitivity C-reactive protein (hs CRP)
Time Frame: once, approximately 30 years after delivery
hs-CRP measured in plasma by Medpace Laboratories . This is an inflammatory marker.
once, approximately 30 years after delivery
Interleukin-6 (IL-6)
Time Frame: once, approximately 30 years after delivery
IL-6 measured in serum by Medpace laboratory. This is an inflammatory marker.
once, approximately 30 years after delivery
Tumor Necrosis Factor alpha receptor 2
Time Frame: once, approximately 30 years after delivery
Tumor Necrosis Factor alpha receptor 2 (TNF alpha receptor 2) is measured in serum by Medpace Laboratories. This is an inflammatory marker.
once, approximately 30 years after delivery
Fibrinogen
Time Frame: once, approximately 30 years after delivery
Fibrinogen is measured in plasma by Medpace Laboratories. This is an inflammatory marker.
once, approximately 30 years after delivery
Resting blood pressure (diastolic)
Time Frame: once, approximately 30 years after delivery
Blood pressure read measured through SphygmoCor XCEL, taken after 10 minutes of sitting quietly.
once, approximately 30 years after delivery
Resting blood pressure (systolic)
Time Frame: once, approximately 30 years after delivery
Blood pressure read measured through SphygmoCor XCEL, taken after 10 minutes of sitting quietly.
once, approximately 30 years after delivery
Carotid to femoral pulse wave velocity (cf-PWV)
Time Frame: once, approximately 30 years after delivery
Pulse wave velocity is a measure of arterial stiffness. It is a predictor of cardiovascular risk. It is measured using the SphygmoCor XCEL instrument.
once, approximately 30 years after delivery
Augmentation index
Time Frame: once, approximately 30 years after delivery
Augmentation Index is a measure of arterial stiffness. It is calculated as the ratio of Augmented Pressure to Pulse pressure. a predictor of cardiovascular risk. It is measured using the SphygmoCor SCEL instrument
once, approximately 30 years after delivery
Mortality - Mothers
Time Frame: measured once, approximately 30 years after delivery.
The study team expects the intervention to reduce the rates of all-cause mortality among mothers given that death is more likely among those with COVID infections who have underlying chronic conditions. Moreover, the study team expects the program to reduce mortality for chronic diseases and CVD among mothers if the rates are sufficiently high to detect such differences.
measured once, approximately 30 years after delivery.
Mortality - Offspring
Time Frame: measured once, approximately 30 years after delivery.

Among offspring, those who become infected with COVID are less likely to die than their mothers, given that their underlying chronic conditions are less likely to be as serious or prevalent. Therefore, the investigators expect the treatment-control differences to be limited to external causes.

Note that in the original proposal the authors had included deaths due preventable causes (SIDS) as operationalized in a recent publication: https://pubmed.ncbi.nlm.nih.gov/34420828/. Given the controversy that has emerged in recent years about whether the causes of SIDS are uniformly preventable, SIDS was added to a modified version of this outcome that includes external cuases, that will be analyzed as an exploratory outcome in examining offspring mortality. The authors also will conduct an exploratory analysis of all-cause mortality.

measured once, approximately 30 years after delivery.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Medical diagnoses, signs, and symptoms
Time Frame: interview conducted approximately 30 years after delivery
Obtained via medical history interview by trained nurses.
interview conducted approximately 30 years after delivery
Current medications
Time Frame: interview conducted approximately 30 years after delivery
Obtained via medical history interview by trained nurses.
interview conducted approximately 30 years after delivery
Number of Hospitalizations per participant (mental/behavioral)
Time Frame: interview conducted approximately 30 years after delivery
Obtained via medical history interview by trained nurses, and by matching administrative hospitalization records (in Tennessee only) to study subjects who have given consent.
interview conducted approximately 30 years after delivery
Number of Hospitalizations per participant (medical/surgical)
Time Frame: interview conducted approximately 30 years after delivery
Obtained via medical history interview by trained nurses, and by matching administrative hospitalization records (in Tennessee only) to study subjects who have given consent.
interview conducted approximately 30 years after delivery
Disability (injury)
Time Frame: interview conducted approximately 30 years after delivery
obtained from 1) administrative data on Social Security disability payment and 2) information derived from the interview regarding if and why participant is receiving Supplemental Security Income.
interview conducted approximately 30 years after delivery
Disability (physical)
Time Frame: interview conducted approximately 30 years after delivery
1) administrative data on Social Security disability payment and 2) information derived from the interview regarding if and why participant is receiving Supplemental Security.
interview conducted approximately 30 years after delivery
Disability (mental illness)
Time Frame: interview conducted approximately 30 years after delivery
1) administrative data on Social Security disability payment and 2) information derived from the interview regarding if and why participant is receiving Supplemental Security Income.
interview conducted approximately 30 years after delivery
Number of pregnancies
Time Frame: interview conducted approximately 30 years after delivery
Self-reports of all pregnancies and dates
interview conducted approximately 30 years after delivery
Pregnancy losses
Time Frame: interview conducted approximately 30 years after delivery
self-reports of all pregnancies not resulting in a live birth
interview conducted approximately 30 years after delivery
Number of live births
Time Frame: interview conducted approximately 30 years after delivery
1) self-reports of all children's dates of births and 2) administrative data
interview conducted approximately 30 years after delivery
Pregnancy complications
Time Frame: interview conducted approximately 30 years after delivery
derived from administrative (birth certificate) data
interview conducted approximately 30 years after delivery
Birthweight
Time Frame: interview conducted approximately 30 years after delivery
determined through a combination of interview and administrative (birth certificate) data
interview conducted approximately 30 years after delivery
Gestational age
Time Frame: interview conducted approximately 30 years after delivery
determined through a combination of interview and administrative (birth certificate) data
interview conducted approximately 30 years after delivery
Menopause (age)
Time Frame: interview conducted approximately 30 years after delivery
Determined via interview
interview conducted approximately 30 years after delivery
Self-rated health
Time Frame: interview conducted approximately 30 years after delivery
Excellent, very good, good, fair, or poor
interview conducted approximately 30 years after delivery
Physical activity - Total Metabolic Equivalent of Task (MET) minutes per week
Time Frame: interview conducted approximately 30 years after delivery
International Physical Activity Questionnaire (IPAQ): questionnaire to obtain internationally comparable data regarding physical activity. Questions ask about quantity and duration of physical activity.
interview conducted approximately 30 years after delivery
Sleep Quality -- Global Score
Time Frame: interview conducted approximately 30 years after delivery
Derived from Pittsburgh Sleep Quality Index (PSQI): questions on the PSQI are rated on a scale of 0-3, 0 = no difficulty to 3 = severe difficulty, and ask questions related to sleep latency, sleep duration, sleep disturbances, use of sleep medication,and daytime dysfunction.
interview conducted approximately 30 years after delivery
Average daily fruit and vegetable intake
Time Frame: interview conducted approximately 30 years after delivery
derived from Diet NIH Eating at America's Table: All-Day Fruit & vegetable Screener
interview conducted approximately 30 years after delivery
Percent energy from fat
Time Frame: interview conducted approximately 30 years after delivery
Derived from National Cancer Institute Percentage Energy from Fat Screener
interview conducted approximately 30 years after delivery
Dietary restraint/eating patterns
Time Frame: interview conducted approximately 30 years after delivery
Derived from Three Factor Eating Questionnaire: Measures three aspects of eating behaviors: cognitive restraint, uncontrolled eating, and emotional eating.
interview conducted approximately 30 years after delivery
Screening for Substance Use - TAPS 1 (tobacco, alcohol, prescription medication, and other substance use)
Time Frame: interview conducted approximately 30 years after delivery
use of substances in the past three months
interview conducted approximately 30 years after delivery
Substance Use Risk Level TAPS 2
Time Frame: interview conducted approximately 30 years after delivery
Risk category: no use in past 3 months, problem use, higher risk Substance Use Dependence
interview conducted approximately 30 years after delivery
Tobacco: Cigarettes
Time Frame: interview conducted approximately 30 years after delivery
Ever smoked cigarettes, age started and stopped smoking, number of cigarettes per day
interview conducted approximately 30 years after delivery
Tobacco: Cigars
Time Frame: interview conducted approximately 30 years after delivery
Ever smoked cigars, aged started and stopped, number of cigars per week
interview conducted approximately 30 years after delivery
Tobacco: Pipe, Hookah
Time Frame: interview conducted approximately 30 years after delivery
Ever smoke tobacco in pipe or hookah, age started and stopped, number of pipe bowls per week
interview conducted approximately 30 years after delivery
Tobacco: Smokeless Tobacco Snus
Time Frame: interview conducted approximately 30 years after delivery
Ever used Snus, age started and stopped, number of snus pouches per week
interview conducted approximately 30 years after delivery
Other Smokeless Tobacco (dip, chewing tobacco)
Time Frame: interview conducted approximately 30 years after delivery
: Ever used dip, chewing tobacco, age started and stopped, number of times per day
interview conducted approximately 30 years after delivery
Tobacco: Electronic Nicotine Products
Time Frame: interview conducted approximately 30 years after delivery
Ever used, age started and stopped, number of times per day
interview conducted approximately 30 years after delivery
Depression
Time Frame: interview conducted approximately 30 years after delivery
Derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression 8a Adult: measures patient-reported outcomes like pain, fatigue, physical functioning, emotional distress, and social role participation.Each question uses a 5-point ordinal scale of "never," "rarely," sometimes," "often," and "always." Higher scores indicate higher depression severity.
interview conducted approximately 30 years after delivery
Anxiety
Time Frame: interview conducted approximately 30 years after delivery
Derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety 8a Adult. 7 Questions about feelings related to anxiety felt in the past seven days. Each question uses a 5-point ordinal scale of "never," "rarely," sometimes," "often," and "always." Higher scores indicate higher anxiety severity.
interview conducted approximately 30 years after delivery
Mastery
Time Frame: interview conducted approximately 30 years after delivery
Derived from Pearlin Mastery Scale. Measured on a 4 point Likert Scale, (1: Strongly Disagree, 4: Strongly agree). Scores can range from 7-28, with higher scores indicating a higher level of mastery.
interview conducted approximately 30 years after delivery
Duration of Marriage and partnered relationships
Time Frame: interview conducted approximately 30 years after delivery
List of current and previous married and partnered relationships, length of time together.
interview conducted approximately 30 years after delivery
Relationship Commitment: Current Relationship
Time Frame: interview conducted approximately 30 years after delivery
Structural commitment (dating, cohabitating, married)
interview conducted approximately 30 years after delivery
Relationship Personal Commitment: Current Relationship
Time Frame: interview conducted approximately 30 years after delivery
not at all committed to extremely committed relationship: 2 indicators of committment: structural and personal commitment. Personal commitment responses: 1-4, 1: not very committed, to 4: extremely committed.
interview conducted approximately 30 years after delivery
Relationship Satisfaction: Current Relationship
Time Frame: interview conducted approximately 30 years after delivery
Overall happiness with relationship and satisfaction with partner: assessed with 2 questions regarding overall happiness and partner satisfaction.
interview conducted approximately 30 years after delivery
Partner Warmth Index: Current Relationship
Time Frame: interview conducted approximately 30 years after delivery
Degree to which partner displayed warm behaviors: 3 questions regarding how often their partner displayed warm behaviors in the past month, ranging from 1-4. 1: never to 4: always.
interview conducted approximately 30 years after delivery
Partner Hostility Index: Current Relationship
Time Frame: interview conducted approximately 30 years after delivery
Degree to which partner displayed hostile behaviors: 5 questions asking about partner hostile behavior in past month, ranging from 1-4. 1: never, 4: always
interview conducted approximately 30 years after delivery
Educational attainment (High School)
Time Frame: interview conducted approximately 30 years after delivery
High school education: graduated from high school, obtained General Education Development (GED), left high school without completing.
interview conducted approximately 30 years after delivery
Educational attainment (College)
Time Frame: interview conducted approximately 30 years after delivery
Highest Degree completed: Associates, Bachelors, Masters, PhD.
interview conducted approximately 30 years after delivery
Educational attainment (job training)
Time Frame: interview conducted approximately 30 years after delivery
Dates and types of job training programs
interview conducted approximately 30 years after delivery
Current work status (job)
Time Frame: interview conducted approximately 30 years after delivery
List of employment, duties, dates of employment
interview conducted approximately 30 years after delivery
Current work status (hours/week)
Time Frame: interview conducted approximately 30 years after delivery
number of hours work per week
interview conducted approximately 30 years after delivery
Arrests and Incarceration
Time Frame: interview conducted approximately 30 years after delivery
Dates and outcomes of arrests
interview conducted approximately 30 years after delivery
Arrests
Time Frame: interview conducted approximately 30 years after delivery
Types of arrests: misdemeanor, felony
interview conducted approximately 30 years after delivery
Arrests and incarceration
Time Frame: interview conducted approximately 30 years after delivery
number of days incarcerated
interview conducted approximately 30 years after delivery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 20, 2020

Primary Completion (Actual)

May 31, 2024

Study Completion (Actual)

May 31, 2024

Study Registration Dates

First Submitted

November 14, 2023

First Submitted That Met QC Criteria

November 28, 2023

First Posted (Actual)

December 7, 2023

Study Record Updates

Last Update Posted (Actual)

January 21, 2026

Last Update Submitted That Met QC Criteria

January 15, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The investigators are only sharing IPD among the institutions involved in the conduct of this study.

IPD Sharing Time Frame

March 1, 2025

IPD Sharing Access Criteria

check with Nancy about this

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF
  • ANALYTIC_CODE
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Chronic Disease

Clinical Trials on Transportation and Developmental Screening

Subscribe