Extending the Analysis of Nurse Family Partnership on Maternal and Child Mortality

To determine the impact of prenatal and infant/toddler nurse home visiting on maternal and child mortality over 20 years following program enrollment. Three randomized controlled trials (Elmira, NY; Memphis, TN; Denver, CO) designed originally to assess program impacts on pregnancy outcomes and maternal and child health through child age 2. Each trial included a control group, a group that received the full intervention (nurse visitation through child age 2), and an alternative treatment group (nurse home visitation through pregnancy only or visitation by paraprofessionals through child age 2). Due to sample size considerations, the Elmira and Denver samples were combined for all mortality analyses. For determining mortality, background information used for determining mortality status was available for all 1138 mothers randomized to a Memphis treatment condition and all but 13 of the live-born children (n=1076). For the combined Elmira and Denver group, background information was available for all 1135 mothers randomized to any one of the treatment conditions and all but 10 of the live born children (n=1087). Pregnant women and their first-born children who were enrolled in one of three trials of the Nurse-Family Partnership (Elmira, Memphis, Denver) were included in the current study. The Elmira sample (N = 400) was enrolled between April 1978 and September 1980 with an 80% recruitment rate. At enrollment, 47% of the participating women were younger than 19 years of age, 62% were unmarried, and 61% came from families in Hollingshead’s social classes IV and V (semi-skilled and unskilled laborers). In the Memphis trial, a total of 1138 out of 1289 eligible women (88.3%) completed informed consent and were randomized from June 1, 1990, through August 31, 1991. We enrolled primarily African American women at less than 29 weeks of gestation, with no previous live births, and with at least 2 of the following socio-demographic risk characteristics: unmarried, less than 12 years of education, and unemployed. Of the women enrolled, 92.1% were African American, 98.1% were unmarried, 64.1% were 18 years or younger at registration, and 85.1% came from households with annual incomes below the US federal poverty guidelines. Denver trial enrollment took place between March 1994 and June 1995 with a total of 735 out of 1178 consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance enrolled in the trial and were randomized to control, paraprofessional, or nurse-visited conditions. 86% of participating women were unmarried, 42% were under 19 years of age, 45% were Latino, and on average participants lived in census tracts where 20% of the population was below the poverty line. The current study was approved by the University of Rochester Institutional Review Board and the Combined Institutional Review Board of the University of Colorado.