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Maternal and Child Mortality: Analysis of Nurse Home Visiting in 3 RCTs
Nancy S Donelan-McCall1, Michael D Knudtson1, David L Olds1
1Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
American Journal of Preventive Medicine
|August 23, 2021
Summary
Intensive nurse home visiting programs may reduce premature death for mothers and children in low-income families. Further research is needed to confirm these findings in larger, diverse populations.
Area of Science:
- Public Health
- Maternal and Child Health
- Epidemiology
Background:
- Low-income mothers and children face higher mortality risks.
- Prenatal and infant/toddler nurse home visiting is an intervention aimed at improving health outcomes.
- Long-term impacts of such programs on survival rates require extensive study.
Purpose of the Study:
- To examine the long-term impact of intensive prenatal and infant/toddler nurse home visiting on maternal and child survival.
- To analyze mortality data over two decades following randomization in randomized controlled trials (RCTs).
Main Methods:
- Analysis of data from three RCTs involving over 1,100 mothers and 1,000 children each.
- Utilized National Death Index data to assess all-cause, external-cause maternal mortality, and preventable-cause child mortality.
- Followed participants for up to two decades post-pregnancy enrollment.
Main Results:
- No significant differences in overall maternal mortality were found between nurse-visited and control groups in specific trial locations.
- Posthoc analysis suggested a potential reduction in external-cause maternal mortality (p=0.054) with nurse home visiting.
- A marginally significant reduction in preventable-cause child mortality was observed in one trial location (p=0.09).
Conclusions:
- Findings support further investigation of nurse home visiting in larger trials with disadvantaged populations.
- Intensive nurse home visiting may offer a strategy to decrease premature mortality among mothers and children in poverty.
- Additional research is warranted to solidify the observed trends and explore mechanisms of impact.
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