Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial

Abstract

Background: Prenatal and infancy home-visiting by nurses is promoted as a means of improving maternal life-course, but evidence of long-term effects is limited. We hypothesized that nurse-visitation would lead to long-term reductions in public-benefit costs, maternal substance abuse and depression, and that cost-savings would be greater for mothers with initially higher psychological resources.

Methods: We conducted an 18-year follow-up of 618 out of 742 low-income, primarily African-American mothers with no previous live births enrolled in an randomized clinical trial of prenatal and infancy home visiting by nurses. We compared nurse-visited and control-group women for public-benefit costs, rates of substance abuse and depression, and examined possible mediators of intervention effects.

Results: Nurse-visited women, compared with controls, incurred $17 310 less in public benefit costs (P = .03), an effect more pronounced for women with higher psychological resources ($28 847, P = .01). These savings compare with program costs of $12 578. There were no program effects on substance abuseor depression. Nurse-visited women were more likely to be married from child age 2 through 18 (19.2% vs 14.8%, P = .04), and those with higher psychological resources had 4.64 fewer cumulative years rearing subsequent children after the birth of the first child (P = .03). Pregnancy planning was a significant mediator of program effects on public benefit costs.

Conclusions: Through child age 18, the program reduced public-benefit costs, an effect more pronounced for mothers with higher psychological resources and mediated by subsequent pregnancy planning. There were no effects on maternal substance abuse and depression.

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 Nurse-Family Partnership (NFP) to conduct research to improve NFP and its implementation; this contract covers part of Dr Olds’ 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 implementation of NFP with quality, but none of the royalties or fees go to Dr Olds personally; they are used to support Prevention Research Center for Family and Child Health research and implementation guidance. Dr Miller performs economic analyses under contract for the nonprofit NFP 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.

Figures

FIGURE 1

Discounted estimates of public benefit costs by year after birth of first child, HPR sample.

FIGURE 2

Discounted estimates of public benefit costs by year after birth of first child, LPR sample.

FIGURE 3

Subsequent-child years over time after birth of first child for NV and control mothers with initially HPR.

FIGURE 4

Rates of self-reported marriage from child age 2 through 18 for NV and women in the control group, whole sample.

FIGURE 5

Maternal wages from birth of first child through child age 16 reported to the SSA for NV women and women in the control group, whole sample.