Care for pregnant women followed up by home visits after childbirth through to toddlerhood reduced death rates for both mothers and children in deprived areas of Memphis studied by a randomized clinical trial.
The results, published in the journal JAMA Pediatrics, suggest that deaths from all causes in the mothers, and deaths from preventable causes in the children, were reduced by the nursing help.
The preventable causes of child death that occurred less often in the groups receiving home visits were:
"Women who had prenatal and infant/toddler nurse visits at home were less likely to die than women who did not, and children whose mothers were visited by nurses were less likely to have died by age 20 from preventable causes."
- Sudden infant death syndrome
- Accidental injury
These data were derived from the National Death Index and the differences in death rates were compared across randomly assigned groups receiving four types of progressively more intensive care in the study:
- Transportation for prenatal care only
- Prenatal transportation plus developmental screening for infants and toddlers
- Transportation plus home visits (prenatal, and for the child up to 2 years of age)
- All of the above care.
The positive findings on reduced death rates were limited in terms of their statistical power, but they have prompted the researchers to call for more work to investigate the outcomes achieved by home visits to deprived populations.
The authors conclude:
"Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings."
"These findings should be replicated in well-powered trials with populations at very high levels of familial and neighborhood risk," the researchers add.
A total of 1,138 mothers took part in the study to receive the four levels of intervention. For child death rates, the results were collated at age 20 years.
The mortality rate was 1.6% among those children who had been in the second group, with mothers getting prenatal transportation and child screening care only, compared with a zero death rate in the fourth group receiving the most intensive care, with the addition of home visits.
Death rates were also higher for the mothers in the low-intervention groups. Mortality from all causes was 3.7% across the mothers in the prenatal transportation group and the second group adding in child screening only. This compared with rates of between 0.4% and 2.2% in the more intensive care groups.
In summary, say the researchers: "Women who had prenatal and infant/toddler nurse visits at home were less likely to die than women who did not, and children whose mothers were visited by nurses were less likely to have died by age 20 from preventable causes."
Charitable assistance for vulnerable first-time mothers
The visits in the study from registered nurses were provided by a non-profit organization known as the Nurse-Family Partnership, which "helps transform the lives of vulnerable first-time moms and their babies."
The evidence-based community health program works by:
- Helping women to:
- get prenatal care from their health care providers
- improve their diet
- reduce their use of cigarettes, alcohol and illegal substances
- Helping parents to improve child health and development through "responsible and competent care"
- Helping parents to improve their economic self-sufficiency.
Another story today reports that nutrition and health 'have greater influence on newborn's size than race'.
In 2010, a report in the Archives of Pediatrics & Adolescent Medicine found that at-risk mothers receiving home care visits for their first-borns were then delaying their next pregnancy, showing an increased likelihood of waiting at least 2 years to have a second child.
Survival of newborns is the subject of other news today - see Preterm newborns 'more likely to survive in busy neonatal centers'.
Written by Markus MacGill