Nurse Visitation During Pregnancy and Infancy Reduced Maternal and Child Mortality

MedicalResearch.com Interview with: David Olds, Ph.D. Professor of Pediatrics and Director Prevention Research Center for Family and Child Health University of Colorado Department of Pediatrics Aurora, Colorado   80045MedicalResearch.com Interview with:
David Olds, Ph.D.
Professor of Pediatrics and Director
Prevention Research Center for Family and Child Health
University of Colorado Department of Pediatrics
Aurora, Colorado   80045


Medical Research: What are the main findings of the study?

Dr. Olds: We’ve conducted a randomized controlled trial of a program of nurse home visiting for low-income women with no previous live firths during pregnancy and the first two years of the child’s life, with randomization of participants beginning in 1990. In our most recent follow-up of mothers and children in Memphis, those who received nurse-visitation were less likely to have died over a 2-decade period following the child’s birth than those in the control group.  Death among mothers and children in these age ranges in the US is rare and extraordinarily important for what it tells us about the health of the population studied in this trial.

For children, the reduction in death was present for preventable causes, that is, sudden infant death syndrome, injuries, and homicide.  All of the child deaths for preventable causes were in the control group, for whom the rate was 1.6%.  None of the nurse-visited children died of preventable causes.

The reductions in maternal mortality were found for two nurse-visited groups combined for this report: one received prenatal and newborn visitation and a second received visitation during pregnancy and through child age two.  Overall, mothers assigned to the control group were nearly 3 times more likely to die than those assigned to the two nurse-visited conditions.  The relative reduction in maternal mortality was particularly pronounced for deaths linked to maternal behaviors — suicide, drug overdose, injuries, and homicide; for these external causes of death, 1.7% of the mothers in the control group had died, compared to 0.2% of those visited by nurses.


Medical Research: Were any of the findings unexpected? 

Dr. Olds: All of these findings were unexpected as we thought that the rates of maternal and child mortality for women and children in these age ranges would be too infrequently occurring to discern program effects.

Medical Research: What should clinicians and patients take away from your report?

Dr. Olds: Nurse visitation during pregnancy and the early years of the child’s life among low-income mothers with no previous live births is a promising means of improving maternal and child health and reducing maternal and child mortality.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Olds: These findings need to be replicated with other highly disadvantaged low-income families.

Citation:

Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. Published online July 07, 2014. doi:10.1001/jamapediatrics.2014.472.