The impact of a rigorous nurse home visiting program on a composite outcome of preterm delivery, low birth weight, small for gestational age, or perinatal death was examined by researchers for a study.
A total of 5,670 Medicaid-eligible, nulliparous pregnant women under 28 weeks gestation participated in this randomized clinical research. Participants were enrolled between April 1, 2016, and March 17, 2020, and follow-up continued until February 2021. Nurse-Family Partnership program (n=3,806) or control (n=1,864) were randomly assigned to participants in a 2:1 ratio. The program follows a tried-and-true approach for nurse home visits, with frequent visits starting before conception and continuing for two years after birth. In relation to maternal life course, child health and development, and prenatal health, nurses offer education, evaluations, and goal-setting. The control group received standard medical care along with a directory of local providers. Staff members and participants weren’t made unaware of the intervention group. There were 3 main results. Based on vital statistics, Medicaid claims, and hospital discharge records until February 2021, the article presents a composite of unfavorable birth outcomes, including preterm delivery, low birth weight, small for gestational age, or perinatal death. The key outcomes of significant injury or suspicion of abuse or neglect in the child’s first 24 months of life, as well as interbirth intervals of fewer than 21 months, have not yet undergone full measurement. The 54 secondary outcomes included all components of the composite as well as birth weight, gestational length, large for gestational age, extremely preterm, very low birth weight, overnight admission to the neonatal intensive care unit, severe maternal morbidity, and cesarean delivery. The outcomes related to maternal and newborn health have also undergone measurement.
In the study, 4,966 of the 5,670 people that were enrolled—3,319 intervention participants and 1,647 control participants—were examined for the main maternal and neonatal health outcomes (median age, 21 years [1.2% non-Hispanic Asian, Indigenous, or Native Hawaiian and Pacific Islander; 5.7% Hispanic; 55.2% non-Hispanic Black; 34.8% non-Hispanic White; & 3.0% more than 1 race reported [non-Hispanic]). Incidence of the composite adverse birth outcome in the intervention group was 26.9%, compared to 26.1% in the control group (adjusted between-group difference of 0.5% [95% CI, -2.1% to 3.1%]). None of the primary or secondary outcomes for mother and newborn health in the entire sample or in any of the predetermined subgroups showed a substantially improved result for the intervention group.
The assignment to take part in an intensive nurse home visiting program did not significantly lower the incidence of a composite of unfavorable birth outcomes in this South Carolina-based study of pregnant people eligible for Medicaid. An incomplete evaluation of this program’s overall performance exists since early childhood and birth spacing outcomes have not yet been examined.
Reference: jamanetwork.com/journals/jama/article-abstract/2793825
