Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial

Abstract

Objectives: Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females.

Methods: We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership).

Results: Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors.

Conclusions: The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.

Trial registration: ClinicalTrials.gov NCT00708695.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The Prevention Research Center for Family and Child Health, directed by Dr Olds at the University of Colorado School of Medicine, has a contract with the Nurse-Family Partnership (NFP) to conduct research to improve the NFP program and its implementation; this contract covers part of Dr Olds’s salary and part of Mr Knudtson’s salary. Dr Olds and Mr Knudtson were employed by this center at the time the study was conducted. Dr Olds is the founder of NFP and, with the University of Colorado, owns the NFP intellectual property. The University of Colorado receives royalties from governments and organizations outside of the United States that implement NFP and has contracts with those entities to guide the implementation of NFP with quality, but none of the royalties or fees go to Dr Olds personally; they are used to support the Prevention Research Center for Family and Child Health research and implementation guidance. Dr Miller performs economic analyses under contract for the nonprofit Nurse-Family Partnership National Service Office; the other authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.