Article

Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation

Pediatrics (Impact Factor: 5.3). 02/1986; 77(1):16-28.
Source: PubMed

ABSTRACT We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)

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    • "Differential effectiveness, however, could represent cultural differences rather than lack of replicability. Olds et al. (1986) "
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    ABSTRACT: Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on three more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8 %, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development; increase breast-feeding; and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand.
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    • "Pk+, Pb+/0, Prepr(+) Olds et al. 1986 EC, ATT other RCT HV: pre+postbirth vs prebirth prenatal-2 yrs 1hr15mins "
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    • " self - report scale used to assess parents ' personal sense of control over life circumstances . Parental sense of personal control has been shown to predict physical abuse risk ( Bugental , Lewis , Lin , Lyon , & Kopeikin , 1999 ) , and has been reported as both a moderator of the impact of home - based child maltreatment prevention strategies ( Olds et al . , 1986 ) and as a positive outcome of such services , as assessed by this scale ( Kitzman et al . , 1997 ) . The seven items were summed using a 4 - point scale ( 1 = " strongly disagree " to 4 = " strongly agree " ) , with higher scores indicating greater sense of personal control ( baseline ¯ X = 23 . 75 , sd = 3 . 93 , range = 15 – 32 , ˛ ="
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